Daniele Roberto Giacobbe1, Carolina Saffioti2, Angela Raffaella Losito3, Matteo Rinaldi4, Caterina Aurilio5, Cesare Bolla6, Silvia Boni7, Guglielmo Borgia8, Novella Carannante9, Giovanni Cassola10, Giancarlo Ceccarelli11, Silvia Corcione12, Daniela Dalla Gasperina13, Francesco Giuseppe De Rosa12, Chiara Dentone14, Stefano Di Bella15, Nicoletta Di Lauria16, Marcello Feasi10, Marco Fiore17, Sara Fossati15, Erica Franceschini18, Andrea Gori19, Guido Granata20, Sara Grignolo7, Paolo Antonio Grossi13, Giuliana Guadagnino21, Filippo Lagi11, Alberto Enrico Maraolo8, Valeria Marinò22, Maria Mazzitelli23, Alessandra Mularoni21, Alessandra Oliva24, Maria Caterina Pace17, Andrea Parisini6, Francesca Patti14, Nicola Petrosillo20, Vincenzo Pota5, Francesca Raffaelli3, Marianna Rossi25, Antonella Santoro18, Carlo Tascini9, Carlo Torti23, Enrico Maria Trecarichi23, Mario Venditti11, Pierluigi Viale4, Alessio Signori26, Matteo Bassetti27, Valerio Del Bono28, Maddalena Giannella4, Malgorzata Mikulska2, Mario Tumbarello3, Claudio Viscoli2. 1. Department of Health Sciences, University of Genoa, Genoa, Italy. Electronic address: daniele.roberto.giacobbe@gmail.com. 2. Department of Health Sciences, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino-IRCCS, Genoa, Italy. 3. Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. 4. Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy. 5. Anaesthesia and Intensive Care Unit, Department of Women, Children, General and Specialistic Surgery, L. Vanvitelli University of Campania, Naples, Italy. 6. SC Malattie Infettive, ASO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. 7. Divisione di Malattie Infettive, Ospedale Sant'Andrea, La Spezia, Italy. 8. Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy. 9. First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy. 10. Department of Infectious Diseases, Galliera Hospital, Genoa, Italy. 11. Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy. 12. Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy. 13. Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy. 14. Medical Department, Infectious Diseases Unit, Sanremo Hospital, Imperia, Italy. 15. Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy. 16. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. 17. Department of Anaesthesiological, Surgical and Emergency Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy. 18. Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy. 19. University of Milan and Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 20. Clinical and Research Department for Infectious Diseases, Severe and Immunedepression-Associated Infections Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy. 21. Infectious Diseases ISMETT IRCCS, Palermo, Italy. 22. IRCCS INM Neuromed, Pozzilli, Italy. 23. Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit, 'Magna Graecia' University of Catanzaro, Catanzaro, Italy. 24. Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy; IRCCS INM Neuromed, Pozzilli, Italy. 25. Clinic of Infectious Diseases, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy. 26. Department of Health Sciences, University of Genoa, Genoa, Italy. 27. Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy. 28. Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy.
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.
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: Marco Fiore; Sveva Di Franco; Aniello Alfieri; Maria Beatrice Passavanti; Maria Caterina Pace; Stephen Petrou; Francesca Martora; Sebastiano Leone Journal: World J Hepatol Date: 2020-12-27