title: Good tolerability of high dose colistin-based therapy in patients with haematological malignancies.
abstract: OBJECTIVE
  Colistin is usually the only drug fully active against multi-drug resistant Gram-negative bacteria, but its nephrotoxicity might limit its use. Recent pharmacokinetic/pharmacodynamic data suggest that high dose of colistin, preceded by a loading dose, are needed to maximize its antibacterial effect. The aim of this study was to determine the safety of high doses colistin, in haematology population.
  
  
  METHODS
  A retrospective review of haematology patients who received high dose colistin-based therapy in years 2011-2016 was performed. Nephrotoxicity was assessed using RIFLE criteria.
  
  
  RESULTS
  Thirty patients who received 38 courses of colistin were included in the study. Colistin was always administered together with other antibiotics. Colistin was well tolerated, with one case of neurological toxicity and one of cutaneous reaction. There were 22 (58%) treatment cycles without any nephrotoxicity, even though during 16 of these cycles other nephrotoxic drugs were administered. Severe (injury or failure) renal toxicity occurred during 6 (16%) treatment courses, requiring colistin discontinuation in 2 patients and colistin dose reduction in 1. Poorer renal function at baseline and younger age were the only variables associated with increased renal toxicity (p = 0.011 and p = 0.031, respectively). Overall mortality was 18% (7/38) and 29% (11/38) at 7 and 30 days after the treatment onset.
  
  
  CONCLUSIONS
  In adult haematology population, high dose colistin therapy is safe and efficacious, despite high frequency of concomitant nephrotoxic treatment.
authors.affiliation: Division of Infectious Diseases, Department of Health Sciences (DISSAL), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Grignolo
authors.affiliation: Division of Infectious Diseases, Department of Health Sciences (DISSAL), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy. paolatatarelli@gmail.com.
authors.forename: Paola
authors.initials: P
authors.lastname: Tatarelli
authors.affiliation: Chair of Hematology, Department of Internal Medicine (DiMI), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Guolo
authors.affiliation: Chair of Hematology, Department of Internal Medicine (DiMI), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Minetto
authors.affiliation: Chair of Hematology, Department of Internal Medicine (DiMI), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Rivoli
authors.affiliation: Chair of Hematology, Department of Internal Medicine (DiMI), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Guardo
authors.affiliation: Division of Infectious Diseases, Department of Health Sciences (DISSAL), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Del Bono
authors.affiliation: Division of Hematology and Hematopoietic Stem Cell Transplantation Unit, IRCCS San Martino-IST, Genoa, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Varaldo
authors.affiliation: Division of Hematology and Hematopoietic Stem Cell Transplantation Unit, IRCCS San Martino-IST, Genoa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gualandi
authors.affiliation: Chair of Hematology, Department of Internal Medicine (DiMI), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Ballerini
authors.affiliation: Division of Hematology and Hematopoietic Stem Cell Transplantation Unit, IRCCS San Martino-IST, Genoa, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Raiola
authors.affiliation: Chair of Hematology, Department of Internal Medicine (DiMI), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Gobbi
authors.affiliation: Division of Infectious Diseases, Department of Health Sciences (DISSAL), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Viscoli
authors.affiliation: Division of Infectious Diseases, Department of Health Sciences (DISSAL), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Mikulska
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003091:Colistin / Q000627:therapeutic use*; D005260:Female; D019337:Hematologic Neoplasms / Q000188:drug therapy*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D003091:Colistin
keywords: Colistin; Haematological malignancies; Hematopoietic stem cell transplantation; Multi-drug resistant bacteria; Nephrotoxicity; RIFLE