What is it about?
Colistin is an old antibiotic that has become a last-resort option against bacteria resistant to almost all other drugs. Italy has a high burden of these multidrug-resistant Gram-negative bacteria. We looked at how colistin was prescribed to 221 adult patients in 22 Italian hospitals. It was mostly given intravenously, as targeted therapy, for bloodstream and lower respiratory tract infections. In most cases it was combined with other antibiotics, and loading and maintenance doses were generally adequate. Combination therapy was more likely for empirical treatment and for carbapenem-resistant Enterobacterales, while patients with chronic kidney failure more often received colistin alone.
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Why is it important?
Colistin is difficult to use: dosing is complex and toxicity, especially to the kidney, is a concern. This nationwide snapshot shows how clinicians in a high-resistance country actually use it in everyday practice, highlighting good adherence to dosing recommendations and areas where antimicrobial stewardship can still improve.
Perspectives
This study is the result of a broad collaboration among many Italian infectious disease centres. Real-life data like these are precious, because they show how guidelines translate, or fail to translate, into everyday decisions at the bedside.
Professor Stefano Di Bella
Universita degli Studi di Trieste
Read the Original
This page is a summary of: Use of colistin in adult patients: A cross-sectional study, Journal of Global Antimicrobial Resistance, March 2020, Elsevier,
DOI: 10.1016/j.jgar.2019.06.009.
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