Ten years with colistin: a retrospective case series

Area of Science:

• Infectious Diseases
• Pharmacology
• Nephrology

Background:

• Colistimethate sodium (CMS) is used for multidrug-resistant gram-negative infections.
• Understanding its 10-year usage trends and outcomes is crucial.

Purpose of the Study:

• To evaluate the 10-year experience with colistimethate sodium (CMS) at Shaare Zedek Medical Center.
• To analyze trends in CMS use, resistance patterns, and patient outcomes, including nephrotoxicity.

Main Methods:

• Retrospective case-series analysis of 5603 admissions receiving CMS from 2004-2014.
• Analysis of patient demographics, admission details, renal function, and microbiology.
• Evaluation of trends in defined daily doses (DDD) for CMS and resistant isolates.

Main Results:

• CMS use (DDD) increased significantly (p=0.04) over the decade.
• No significant increase in multidrug-resistant organisms observed.
• High susceptibility rates for bloodstream (98%) and urine (100%) isolates to CMS (excluding intrinsically resistant organisms).
• Mean patient age 80±14 years; 58.4% hospital discharge rate; 2.3% required dialysis.
• No significant increase in nephrotoxicity observed.

Conclusions:

• CMS use has risen without a concurrent increase in resistant strains.
• CMS demonstrated acceptable safety regarding nephrotoxicity in this cohort.
• CMS should be reserved for confirmed extensively drug-resistant gram-negative infections.