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

52OBJECTIVES: The objective of this study was to assess the use of colistin in a country endemic for multidrug-resistant Gram-negative bacteria (MDR-GNB). METHODS: Colistin prescription patterns were evaluated in 22 Italian centers. Factors associated with use of colistin in combination with other anti-MDR-GNB agents were also assessed. RESULTS: During the study period, 221 adults receiving colistin were included in the study. Their median age was 64 years (interquartile range 52-73), and 134 were males (61%). 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 million units of colistimethate was administered in 79% of patients, and adequate maintenance doses in 85%. In multivariable analysis, empirical therapy (odds ratio [OR] 3.25, 95% confidence intervals [CI] 1.24-8.53, p = 0.017) and targeted therapy of carbapenem-resistant Enterobacterales infections (OR 4.76, 95% CI 1.69-13.43, p = 0.003) were associated with use of colistin in combinations with other agents, while chronic renal failure (OR 0.39, 95% CI 0.17-0.88, p = 0.024) was associated with use of colistin as monotherapy. CONCLUSIONS: Colistin remains an important option for severe MDR-GNB infections when other treatments are not available. Despite inherent difficulties in optimizing its use due to peculiar PK/PD characteristics, colistin was mostly used appropriately in a country endemic for MDR-GNB.partially_openembargoed_20200616Daniele Roberto Giacobbe, Carolina Saffioti1, 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 ViscoliRoberto Giacobbe, Daniele; Saffioti1, Carolina; Raffaella Losito, Angela; Rinaldi, Matteo; Aurilio, Caterina; Bolla, Cesare; Boni, Silvia; Borgia, Guglielmo; Carannante, Novella; Cassola, Giovanni; Ceccarelli, Giancarlo; Corcione, Silvia; Dalla Gasperina, Daniela; Giuseppe De Rosa, Francesco; Dentone, Chiara; DI BELLA, Stefano; Di Lauria, Nicoletta; Feasi, Marcello; Fiore, Marco; Fossati, Sara; Franceschini, Erica; Gori, Andrea; Granata, Guido; Grignolo, Sara; Antonio Grossi, Paolo; Guadagnino, Giuliana; Lagi, Filippo; Enrico Maraolo, Alberto; Marinò, Valeria; Mazzitelli, Maria; Mularoni, Alessandra; Oliva, Alessandra; Caterina Pace, Maria; Parisini, Andrea; Patti, Francesca; Petrosillo, Nicola; Pota, Vincenzo; Raffaelli, Francesca; Rossi, Marianna; Santoro, Antonella; Tascini, Carlo; Torti, Carlo; Maria Trecarichi, Enrico; Venditti, Mario; Viale, Pierluigi; Signori, Alessio; Bassetti, Matteo; Del Bono, Valerio; Giannella, Maddalena; Mikulska, Malgorzata; Tumbarello, Mario; Viscoli, Claudi