Abstract
BackgroundThe use of the antibiotic colistin was increasing as a treatment option for multidrug-resistant (MDR) infections. Standardisation of colistin dosing and more appropriate record-keeping practices were required to fully assess the optimal usage of colistin. The aim of this study was to determine how and why colistin was used in the treatment of MDR infections in a tertiary care public hospital in South Africa (SA).MethodsThis cross-sectional retrospective record review described adult and paediatric patients who received colistin intravenously from 01 May 2016 to 31 April 2017. Information from patient records were captured on a data collection tool and analysed using descriptive statistics. Ethical approval was obtained from the Human Research Ethics Committee of the University of the Witwatersrand.ResultsA total of 43 patient records were reviewed. Acinetobacter baumannii was the most common organism isolated (85.2% adults and 62.5% paediatrics). Colistin was mostly prescribed for sepsis (18 adults and 15 paediatrics). Most adults (66.7%) received loading doses as recommended; however, there was a great variation in maintenance doses. Paediatric patients reviewed also showed varying dosing according to weight. The mean duration of colistin therapy was 10 days. Carbapenems were most commonly co-administered with colistin (58%).ConclusionThe findings suggested that although colistin usage was restricted in the hospital, it was not adequately monitored or controlled. Doses prescribed were made at the discretion of prescribing doctors and differed to currently accepted guidelines. Improved record-keeping practices related to the monitoring of colistin use were required.
Highlights
Colistin has widely been considered to be the last resort therapy for multidrug-resistant (MDR) infections.[1,2] MDR infections are generally considered to be microbes, which display resistance to three or more antimicrobial classes.[3,4] Microbial resistance to antibiotic classes such as cephalosporins, aminoglycosides, quinolones and carbapenems has contributed to an increase in the use of colistin globally.[5]
This finding is similar to a colistin usage study in four private sector hospitals in South Africa (SA), where it was noted that loading and maintenance doses were inconsistent and variable.[1]
This study described the use of colistin in adult and paediatric patients admitted to a tertiary public hospital over a 1-year period
Summary
Colistin has widely been considered to be the last resort therapy for multidrug-resistant (MDR) infections.[1,2] MDR infections are generally considered to be microbes, which display resistance to three or more antimicrobial classes.[3,4] Microbial resistance to antibiotic classes such as cephalosporins, aminoglycosides, quinolones and carbapenems has contributed to an increase in the use of colistin globally.[5] In South Africa (SA), colistin is used as salvage therapy for life-threatening infections,[1,2] especially where resistance to the carbapenem class of antibiotics has been observed.[6] The carbapenems have been considered to be part of the last line of defence against MDR gram-negative bacterial infections.[7] the increase in microbial resistance to carbapenems and other antibiotic classes has led to the increased use of colistin in SA. The use of the antibiotic colistin was increasing as a treatment option for multidrug-resistant (MDR) infections. The aim of this study was to determine how and why colistin was used in the treatment of MDR infections in a tertiary care public hospital in South Africa (SA)
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