Dirençli gram negatif bakteri enfeksiyonlarında kolistin uygulamasının sonuçlarının değerlendirilmesi
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Date
2015
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Tıp Fakültesi
Abstract
Colistin which is a concentration-dependent antibiotic belongs to the polymyxin group of cyclic cationic polypeptide antibiotics. Application of colistin varies due to it's compex pharmacokinetic and pharmacodynamic features. In this study, we aimed to evaluate the use of colistin in our hospital. All the patients (193) who were hospitalized in Ankara University Medical Faculty Hospital between the dates of 01 May 2014-31 December 2014 (8 months long period), older than 18 years of age and received specific or empiric colistin treatment, were enrolled in this study. The patients were identified from information management system of the hospital and on pharmacy registries. Patient datas were retrospectively scanned. Age, gender, hospital wards, comorbidities, site of infection, culture results and susceptibilities (if known), doses and durations of colistin treatment, concomitant antibiotics and nephrotoxic agents, effectivity of the treatment, side effects, clinical and microbiological responses were recorded. Clinical responses of the patients were evaluated by considering white blood cell count, c-reactive protein and fever. Colistin was usually used empirically or in patients whose cultures grew multiple drug resistant gram negative microorganisms. Colistin was administered approximately on the 20 th day of hospital admission. Carbapenems were the most choiced drug in combination therapy. Colistin doses were detected to be different and loading dose was not administered in 98% of patients. Inhaler and intrathecal treatment doses were administered in accordance with the literature suggestions. Intrathecal colistin administration was always followed by IV colistin administration however occasionally single inhaler colistin was administered. When single inhaler colistin and inhaler-IV colistin combination were compared, no difference was found in cure rates. Most common side effect therapy was nephrotoxicity (25,4%) and neurotoxicity (3.6%) . The univariate and multivariate analyses revealed that the advanced age was the only factor which affected the development of nephrotoxicity (P= 0.0004). Colistin treatment was terminated in 19 patients out of 193 due to the side effects. Rate of colistin resistance among infectious agents was 4,3%. The colistin resistance was developed on the 19.9 ± 9.4 days of the treatment. Cure rates in colistin receiving patients was 56% and the most crucial factor determining the mortality was the advanced age (63.9 ± 2) (P=0.001). As a result of the study, colistin is one of a limited number of treatment options for multiple drug resistant gram negative bacterial infections and nephrotoxicity is the most common side effect (25,4%) of colistin. However the treatment was rarely terminated baecause of the nephrotoxicity . Different practices of IV colistin application are preferred in our hospital; the loading dose suggested in drug prospectuses and literature are not adopted in most cases (98%). Although colistin resistance is not an important issue today, observation of resistance development in colistin using patients consider us that colistin should be used only when indicated and in appropriate dose and durations in order to avoid development of resistance.
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Bakteriyel enfeksiyonlar, Gram negatif bakteriler