Journal of Global Antimicrobial Resistance (Mar 2020)
Use of colistin in adult patients: A cross-sectional study
- 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
Affiliations
- Daniele Roberto Giacobbe
- Department of Health Sciences, University of Genoa, Genoa, Italy; Corresponding author. Present address: University of Genoa, Dipartimento di Scienze della Salute (DISSAL), Via Antonio Pastore 1, 16132 Genoa, Italy.
- Carolina Saffioti
- Department of Health Sciences, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino–IRCCS, Genoa, Italy
- Angela Raffaella Losito
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- Matteo Rinaldi
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum–University of Bologna, Bologna, Italy
- Caterina Aurilio
- Anaesthesia and Intensive Care Unit, Department of Women, Children, General and Specialistic Surgery, L. Vanvitelli University of Campania, Naples, Italy
- Cesare Bolla
- SC Malattie Infettive, ASO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Silvia Boni
- Divisione di Malattie Infettive, Ospedale Sant’Andrea, La Spezia, Italy
- Guglielmo Borgia
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
- Novella Carannante
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy
- Giovanni Cassola
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
- Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
- Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
- Daniela Dalla Gasperina
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
- Chiara Dentone
- Medical Department, Infectious Diseases Unit, Sanremo Hospital, Imperia, Italy
- Stefano Di Bella
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
- Nicoletta Di Lauria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Marcello Feasi
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
- Marco Fiore
- Department of Anaesthesiological, Surgical and Emergency Sciences, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
- Sara Fossati
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
- Erica Franceschini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
- Andrea Gori
- University of Milan and Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Guido Granata
- Clinical and Research Department for Infectious Diseases, Severe and Immunedepression-Associated Infections Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
- Sara Grignolo
- Divisione di Malattie Infettive, Ospedale Sant’Andrea, La Spezia, Italy
- Paolo Antonio Grossi
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Giuliana Guadagnino
- Infectious Diseases ISMETT IRCCS, Palermo, Italy
- Filippo Lagi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
- Alberto Enrico Maraolo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
- Valeria Marinò
- IRCCS INM Neuromed, Pozzilli, Italy
- Maria Mazzitelli
- Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit, ‘Magna Graecia’ University of Catanzaro, Catanzaro, Italy
- Alessandra Mularoni
- Infectious Diseases ISMETT IRCCS, Palermo, Italy
- Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy; IRCCS INM Neuromed, Pozzilli, Italy
- Maria Caterina Pace
- Department of Anaesthesiological, Surgical and Emergency Sciences, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
- Andrea Parisini
- SC Malattie Infettive, ASO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Francesca Patti
- Medical Department, Infectious Diseases Unit, Sanremo Hospital, Imperia, Italy
- Nicola Petrosillo
- Clinical and Research Department for Infectious Diseases, Severe and Immunedepression-Associated Infections Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
- Vincenzo Pota
- Anaesthesia and Intensive Care Unit, Department of Women, Children, General and Specialistic Surgery, L. Vanvitelli University of Campania, Naples, Italy
- Francesca Raffaelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- Marianna Rossi
- Clinic of Infectious Diseases, San Gerardo Hospital, University of Milano–Bicocca, Monza, Italy
- Antonella Santoro
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
- Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy
- Carlo Torti
- Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit, ‘Magna Graecia’ University of Catanzaro, Catanzaro, Italy
- Enrico Maria Trecarichi
- Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit, ‘Magna Graecia’ University of Catanzaro, Catanzaro, Italy
- Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
- Pierluigi Viale
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum–University of Bologna, Bologna, Italy
- Alessio Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Matteo Bassetti
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
- Valerio Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
- Maddalena Giannella
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum–University of Bologna, Bologna, Italy
- Malgorzata Mikulska
- Department of Health Sciences, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino–IRCCS, Genoa, Italy
- Mario Tumbarello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- Claudio Viscoli
- Department of Health Sciences, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino–IRCCS, Genoa, Italy
- Journal volume & issue
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Vol. 20
pp. 43 – 49
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.
