520. The Clinical Profile and Outcomes of Patients given Intravenous Colistin for Multidrug-Resistant Gram-negative Infections in a Philippine Tertiary Hospital

Abstract

BackgroundColistimethate sodium (colistin) is used to treat multi-drug-resistant Gram-negative infections. We describe the profile and outcomes of patients given colistin in a tertiary level government hospital.MethodsWe performed a retrospective cross-sectional study of patients from the Philippine General Hospital given intravenous colistin between January 2015 to June 2018. Adult patients who received colistin for at least 24 hours and not on dialysis were included. Clinical success was defined as a composite of hemodynamic stability, stable quick Sequential Organ Failure Assessment score (qSOFA), and microbiological cure. Overall in-hospital mortality was recorded.ResultsWe included 250 patients during the study period. The median age was 55 (19–91) years, 55.6% (139/250) were male, and 49.2% (123/250) were admitted in the intensive care unit (ICU). 77.2% (193/250) had at least one comorbidity, with solid-organ malignancy (27.6%, 69/250) being the most common. Most patients had at least one invasive device, commonly a nasogastric tube (64.4%, 161/250) or mechanical ventilator (63.2%, 150/250). There was an increase in Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score, qSOFA, and septic shock from baseline to 24 hours prior to colistin use (Table 1). The most common site of infection was the respiratory tract (90.8%, 227/250). Majority of patients (78.8%, 197/250) had Acinetobacter baumannii infection of which 79.9% were extensively drug-resistant (XDR), susceptible only to colistin and amikacin or minocycline. Colistin was given for a mean of 12 (2- 43) days, concomitant with meropenem in 96.4% (241/250). Most patients received piperacillin–tazobactam (59%, 142/250) and/or meropenem (58%, 138/250) within the same admission. Nephrotoxicity (30.8%, 77/250) was the most frequent adverse effect (Table 2). Renal replacement therapy was needed in 6% (15/250) patients. Clinical success was seen in 61.2% (153/250) patients and overall mortality was 41.6% (104/250).ConclusionColistin was frequently used in combination with a carbapenem for treatment of XDR-related respiratory infection or septic shock. Nephrotoxicity was a common adverse effect. The clinical success rate was modest and overall mortality was high. Disclosures All authors: No reported disclosures.