Efficacy and safety of colistin for the treatment of infections caused by multidrug-resistant gram-negative bacilli

J Infect Chemother. 2021 Mar;27(3):473-479. doi: 10.1016/j.jiac.2020.10.024. Epub 2020 Nov 2.

Abstract

Background: The efficacy and safety of colistin for the treatment of infections caused by multidrug-resistant gram-negative bacilli have been poorly investigated in Japanese patients. This study was performed to investigate the efficacy and safety of colistin in Japanese patients by analyzing a considerable number of cases. Furthermore, we evaluated the relationship between the plasma concentration and efficacy and safety of colistin in some cases.

Methods: A retrospective cohort study was conducted at Hokkaido University Hospital, analyzing patients treated with colistin (colistimethate sodium) during the period from January 2007 to December 2019.

Results: Overall, 42 cases were enrolled. Favorable clinical response was observed in 25 cases (59.5%), with an all-cause 30-day mortality of 33.3% (14/42 cases). Microbiological eradication was achieved in 18 cases (42.9%). Nephrotoxicity was observed in 20 cases (47.6%) and was mild and reversible in all cases. Plasma trough concentrations of colistin determined in nine patients correlated with changes in serum creatinine concentration (⊿) and creatinine clearance (%). The cutoff value of colistin trough concentration for nephrotoxicity was 2.02 μg/mL.

Conclusion: Our results showed approximately 60% clinical efficacy of colistin therapy against infections caused by multidrug-resistant gram-negative bacilli in the patients. Further studies with larger populations are needed to elucidate the efficacy and safety of colistin in Japanese patients.

Keywords: Acinetobacter baumannii; Colistin; Multidrug resistance; Nephrotoxicity; Pseudomonas aeruginosa; Therapeutic drug monitoring.

MeSH terms

  • Acinetobacter baumannii*
  • Anti-Bacterial Agents / adverse effects
  • Colistin / adverse effects
  • Drug Resistance, Multiple, Bacterial
  • Gram-Negative Bacteria
  • Gram-Negative Bacterial Infections* / drug therapy
  • Humans
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Colistin