Use of colistin in adult patients: A cross-sectional study

Giacobbe, D. R.; Saffioti, C.; Losito, A. R.; Rinaldi, M.; Aurilio, C.; Bolla, C.; Boni, S.; Borgia, G.; Carannante, N.; Cassola, G.; Ceccarelli, G.; Corcione, S.; Dalla Gasperina, D.; De Rosa, F. G.; Dentone, C.; Di Bella, S.; Di Lauria, N.; Feasi, M.; Fiore, M.; Fossati, S.; Franceschini, E.; Gori, A.; Granata, G.; Grignolo, S.; Grossi, P. A.; Guadagnino, G.; Lagi, F.; Maraolo, A. E.; Marino, V.; Mazzitelli, M.; Mularoni, A.; Oliva, A.; Pace, M. C.; Parisini, A.; Patti, F.; Petrosillo, N.; Pota, V.; Raffaelli, F.; Rossi, M.; Santoro, A.; Tascini, C.; Torti, C.; Trecarichi, E. M.; Venditti, M.; Viale, P.; Signori, A.; Bassetti, M.; Del Bono, V.; Giannella, M.; Mikulska, M.; Tumbarello, M.; Viscoli, C.

doi:10.1016/j.jgar.2019.06.009

Objectives: The aim of this study was to assess colistin use in a country endemic for multidrug-resistant Gram-negative bacteria (MDR-GNB). Methods: Colistin prescription patterns were evaluated in 22 Italian centres. Factors associated with use of colistin in combination with other anti-MDR-GNB agents were also assessed. Results: A total of 221 adults receiving colistin were included in the study. Their median age was 64 years (interquartile range 52–73 years) and 134 (61%) were male. Colistin was mostly administered intravenously (203/221; 92%) and mainly for targeted therapy (168/221; 76%). The most frequent indications for colistin therapy were bloodstream infection and lower respiratory tract infection. Intravenous colistin was administered in combination with at least another anti-MDR-GNB agent in 80% of cases (163/203). A loading dose of 9 MU of colistimethate was administered in 79% of patients receiving i.v. colistin and adequate maintenance doses in 85%. In multivariable analysis, empirical therapy [odds ratio (OR) = 3.25, 95% confidence interval (CI) 1.24–8.53;P = 0.017] and targeted therapy for carbapenem-resistant Enterobacterales infection (OR = 4.76, 95% CI 1.69–13.43; P = 0.003) were associated with use of colistin in combination with other agents, whilst chronic renal failure (OR = 0.39, 95% CI 0.17–0.88; P = 0.024) was associated with use of colistin monotherapy. Conclusion: Colistin remains an important option for severe MDR-GNB infections when other treatments are not available. Despite inherent difficulties in optimising its use owing to peculiar pharmacokinetic/pharmacodynamic characteristics, colistin was mostly used appropriately in a country endemic for MDR-GNB.

Use of colistin in adult patients: A cross-sectional study / Giacobbe D.R.; Saffioti C.; Losito A.R.; Rinaldi M.; Aurilio C.; Bolla C.; Boni S.; Borgia G.; Carannante N.; Cassola G.; Ceccarelli G.; Corcione S.; Dalla Gasperina D.; De Rosa F.G.; Dentone C.; Di Bella S.; Di Lauria N.; Feasi M.; Fiore M.; Fossati S.; Franceschini E.; Gori A.; Granata G.; Grignolo S.; Grossi P.A.; Guadagnino G.; Lagi F.; Maraolo A.E.; Marino V.; Mazzitelli M.; Mularoni A.; Oliva A.; Pace M.C.; Parisini A.; Patti F.; Petrosillo N.; Pota V.; Raffaelli F.; Rossi M.; Santoro A.; Tascini C.; Torti C.; Trecarichi E.M.; Venditti M.; Viale P.; Signori A.; Bassetti M.; Del Bono V.; Giannella M.; Mikulska M.; Tumbarello M.; Viscoli C.. - In: JOURNAL OF GLOBAL ANTIMICROBIAL RESISTANCE. - ISSN 2213-7165. - ELETTRONICO. - 20:(2020), pp. 43-49. [10.1016/j.jgar.2019.06.009]