Ten years with colistin: a retrospective case series.
OBJECTIVE
At the Shaare Zedek Medical Center, we have been using colistimethate sodium (CMS) for empiric as well as pathogen-directed treatment. We present our 10-year experience.


METHODS
We conducted a retrospective case-series analysis of patients admitted from 1 January 2004 through 1 May 2014 who received at least one dose of CMS. Patient characteristics analysed for all admission for which patients received CMS, included: age, number of re-admissions, admission ward, renal function, disposition and microbiology results. Overall trend in defined daily dose (DDD) for CMS and resistant isolates was analysed.


RESULTS
A total of 5603 admissions met inclusion criteria. Patients' mean (±SD) age was 80 ± 14 years, 1162 (48%) of the admissions were from a healthcare facility and 4367 (78%) of the admissions were to general Internal Medicine wards. The median number of hospital admissions per patient was 5, median admission and discharge creatinine (mg/dl) were 1.05 and 1.01, respectively; 2.3% of admissions required first-time dialysis. The discharge rate from the hospital was 58.4%. Excluding intrinsically CMS-resistant gram-negative organisms, bloodstream and urine isolates were 98% and 100% susceptible, respectively. CMS use (DDDs) increased during the study (p for trend = 0.04) without significant increase in incidence of multidrug-resistant organisms.


CONCLUSIONS
Colistimethate sodium use at our institution has increased during this 10-year period. Nevertheless, there is no increasing trend in CMS-resistant organisms, 58% of the patients were discharged alive, and we did not observe significant nephrotoxicity in patients prescribed CMS. CMS should be reserved for microbiologically confirmed extensively drug-resistant gram-negative infections.
Department of Internal Medicine D, Shaare Zedek Medical Center, Affiliated with the Hebrew-University Hadassah-Medical School, Jerusalem, Israel. dkatz@szmc.org.il.
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Katz
Infectious Disease Unit, Assaf Harofeh Medical Center, Zerifin, Israel.
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Marchaim
Clinical Microbiology and Immunology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel.
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Assous
Division of Internal Medicine and Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
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Yinnon
Division of Internal Medicine and Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
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Wiener-Well
Division of Internal Medicine and Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
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Ben-Chetrit
D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003091:Colistin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy; D003428:Cross Infection / Q000188:drug therapy; D024881:Drug Resistance, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D012141:Respiratory Tract Infections / Q000188:drug therapy; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000188:drug therapy
D000900:Anti-Bacterial Agents; C004691:colistinmethanesulfonic acid; D003091:Colistin