Year: 2019
Type: article
Study design: Observational Study
Abstract: 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.
Authors: Daniele Roberto Giacobbe, Carolina Saffioti, Angela Raffaella Losito, Matteo Rinaldi, Caterina Aurilio, Cesare Bolla, Silvia Boni, Guglielmo Borgia, Novella Carannante, Giovanni Cassola, Giancarlo Ceccarelli, Silvia Corcione, Daniela Dalla Gasperina, Francesco Giuseppe De Rosa, Chiara Dentone, Stefano Di Bella, Nicoletta Di Lauria, Marcello Feasi, Marco Fiore, Sara Fossati, Erica Franceschini, Andrea Gori, Guido Granata, Sara Grignolo, Paolo Antonio Grossi, Giuliana Guadagnino, Filippo Lagi, Alberto Enrico Maraolo, Valeria Marinò, Maria Mazzitelli, Alessandra Mularoni, Alessandra Oliva, Maria Caterina Pace, Andrea Parisini, Francesca Patti, Nicola Petrosillo, Vincenzo Pota, Francesca Raffaelli, Marianna Rossi, Antonella Santoro, Carlo Tascini, Carlo Torti, Enrico Maria Trecarichi, Mario Venditti, Pierluigi Viale, Alessio Signori, Matteo Bassetti, Valerio Del Bono, Maddalena Giannella, Malgorzata Mikulska, Mario Tumbarello, Claudio Viscoli
Institutions: University of Genoa, Ospedale Policlinico San Martino, Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, University of Bologna, University of Campania "Luigi Vanvitelli", Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, University of Naples Federico II, Ospedale D. Cotugno, Ente Ospedaliero Ospedali Galliera, Policlinico Umberto I, Sapienza University of Rome, University of Turin, University of Insubria, Ospedale di Sanremo, Azienda Sanitaria Universitaria Integrata di Trieste, University of Florence, University of Modena and Reggio Emilia, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Istituto Neurologico Mediterraneo, Magna Graecia University, Azienda Ospedaliera San Gerardo, University of Milano-Bicocca, University of Udine, Azienda sanitaria universitaria Friuli Centrale, Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo
Language: English
Subfield: Microbiology (medical)
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $2,500
OpenAlex ID: W2952699331