Use of colistin in adult patients: A cross-sectional study.
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Giacobbe Daniele Roberto, Saffioti Carolina, Losito Angela Raffaella, Rinaldi Matteo, Aurilio Caterina, Bolla Cesare, Boni Silvia, Borgia Guglielmo, Carannante Novella, Cassola Giovanni, Ceccarelli Giancarlo, Corcione Silvia, Dalla Gasperina Daniela, De Rosa Francesco Giuseppe, Dentone Chiara, Di Bella Stefano, Di Lauria Nicoletta, Feasi Marcello, Fiore Marco, Fossati Sara, Franceschini Erica, Gori Andrea, Granata Guido, Grignolo Sara, Grossi Paolo Antonio, Guadagnino Giuliana, Lagi Filippo, Maraolo Alberto Enrico, Marinò Valeria, Mazzitelli Maria, Mularoni Alessandra, Oliva Alessandra, Pace Maria Caterina, Parisini Andrea, Patti Francesca, Petrosillo Nicola, Pota Vincenzo, Raffaelli Francesca, Rossi Marianna, Santoro Antonella, Tascini Carlo, Torti Carlo, Trecarichi Enrico Maria, Venditti Mario, Viale Pierluigi, Signori Alessio, Bassetti Matteo, Del Bono Valerio, Giannella Maddalena, Mikulska Malgorzata, Tumbarello Mario, Viscoli Claudio, SITA GIOVANI (Young Investigators Group of the Società Italiana Terapia Antinfettiva) and the COLI-CROSS Study Group
Аннотация
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.