Effectiveness and safety of colistin: prospective comparative cohort study

Background Colistin has re-entered clinical use by necessity. We aimed to assess its effectiveness and safety compared with newer antibiotics. Methods This was a single-centre, prospective cohort study. Inclusion criteria were microbiologically documented pneumonia, urinary tract infection, surgical...

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Bibliographic Details
Published in:Journal of antimicrobial chemotherapy 2010-05, Vol.65 (5), p.1019-1027
Main Authors: Paul, Mical, Bishara, Jihad, Levcovich, Ariela, Chowers, Michal, Goldberg, Elad, Singer, Pierre, Lev, Shaul, Leon, Perla, Raskin, Maria, Yahav, Dafna, Leibovici, Leonard
Format: Article
Language:English
Subjects:
Acinetobacter
Adult
Aged
Anti-Bacterial Agents - adverse effects
Anti-Bacterial Agents - therapeutic use
Antibiotics
Antibiotics. Antiinfectious agents. Antiparasitic agents
Bacterial infections
Biological and medical sciences
Clinical outcomes
Cohort Studies
Colistin - adverse effects
Colistin - therapeutic use
Cross Infection - drug therapy
Cross Infection - mortality
Drug Resistance, Multiple, Bacterial
Drug therapy
Effectiveness studies
Female
General aspects
Gram-Negative Bacteria - drug effects
Gram-Negative Bacteria - isolation & purification
Gram-Negative Bacterial Infections - drug therapy
Gram-Negative Bacterial Infections - mortality
hospital-acquired infections
Human infectious diseases. Experimental studies and models
Humans
Infectious diseases
Klebsiella
Male
Medical sciences
Middle Aged
multidrug-resistant Gram-negative bacteria
Pharmacology. Drug treatments
polymyxin
Prospective Studies
Proteus
Survival Analysis
Treatment Outcome
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Summary:Background Colistin has re-entered clinical use by necessity. We aimed to assess its effectiveness and safety compared with newer antibiotics. Methods This was a single-centre, prospective cohort study. Inclusion criteria were microbiologically documented pneumonia, urinary tract infection, surgical site infection, meningitis or bacteraemia treated appropriately with colistin versus imipenem, meropenem or ampicillin/sulbactam (comparators). All consecutive patients were included, only once, between May 2006 and July 2009. The primary outcome was 30 day mortality. Multivariable and Cox regression survival analyses were used to adjust comparisons between groups. Odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals are reported. Results Two hundred patients treated with colistin and 295 patients treated with comparators were included. Treatment with colistin was associated with older age, admission from healthcare facilities, mechanical ventilation and lower rate of early appropriate antibiotic treatment. The 30 day mortality was 39% (78/200) for colistin versus 28.8% (85/295) for comparators; unadjusted OR 1.58 (1.08–2.31). In the adjusted analysis the OR was 1.44 (0.91–2.26) overall and 1.99 (1.06–3.77) for bacteraemic patients (n = 220). At the end of follow-up, treatment with colistin was significantly associated with cumulative mortality; adjusted HR 1.27 (1.01–1.60) overall and 1.65 (1.18–2.31) among patients with bacteraemia. Nephrotoxicity at the end of treatment was more frequent with colistin; OR adjusted for other risk factors for nephrotoxicity 3.31 (1.54–7.08). Treatment with colistin was followed by increased incidence of Proteus spp. infections during a 3 month follow-up. Conclusions The need for colistin treatment is associated with poorer survival. Adjusted analyses suggest that colistin is less effective and more toxic than β-lactam antibiotics.
ISSN:0305-7453
1460-2091
DOI:10.1093/jac/dkq069