Document Detail

Effectiveness and safety of colistin: prospective comparative cohort study.
MedLine Citation:
PMID:  20299494     Owner:  NLM     Status:  MEDLINE    
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 beta-lactam antibiotics.
Mical Paul; Jihad Bishara; Ariela Levcovich; Michal Chowers; Elad Goldberg; Pierre Singer; Shaul Lev; Perla Leon; Maria Raskin; Dafna Yahav; Leonard Leibovici
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-03-18
Journal Detail:
Title:  The Journal of antimicrobial chemotherapy     Volume:  65     ISSN:  1460-2091     ISO Abbreviation:  J. Antimicrob. Chemother.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-09     Completed Date:  2010-06-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7513617     Medline TA:  J Antimicrob Chemother     Country:  England    
Other Details:
Languages:  eng     Pagination:  1019-27     Citation Subset:  IM    
Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
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MeSH Terms
Anti-Bacterial Agents / adverse effects*,  therapeutic use*
Cohort Studies
Colistin / adverse effects*,  therapeutic use*
Cross Infection / drug therapy*,  mortality
Drug Resistance, Multiple, Bacterial
Gram-Negative Bacteria / drug effects,  isolation & purification
Gram-Negative Bacterial Infections / drug therapy*,  mortality
Middle Aged
Prospective Studies
Survival Analysis
Treatment Outcome
Reg. No./Substance:
0/Anti-Bacterial Agents; 1066-17-7/Colistin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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