Colistin utilization at a tertiary hospital in South Africa: an opportunity for antimicrobial stewardship practices

Abstract

Introduction. Colistin (polymyxin E) has emerged as a last-resort treatment option for multidrug-resistant infections. Hypothesis/Gap Statement. Studies on the use, safety and efficacy of colistin in South Africa are limited. Aim. This study aims to describe the use of colistin and its clinical outcomes at a tertiary public hospital in South Africa. Methodology. We conducted a retrospective review of adult and paediatric patients who received parenteral colistin between 2015 and 2019. Results. A total of 69 patients (26 adults, 13 children and 30 neonates) were reviewed. Acinetobacter baumannii was the most common causative pathogen isolated (70.1 %). Colistin was predominately used to treat septicaemia (75.4 %). It was primarily administered as definitive therapy (71.0 %) and as monotherapy (56.5 %). It was used in 11.5 % of adults with infections susceptible to other antibiotics. Loading doses of intravenous colistin were administered in only 15 (57.7 %) adult patients. Neurotoxicity and nephrotoxicity occurred in 5.8 % and 43.5 % of patients, respectively. Clinical cure was achieved in 37 (53.6 %) patients. On multivariate logistic regression analysis, adults [adjusted odds ratio (aOR), 25.54; 95 % CI, 2.73–238.65; P < 0.01] and children (aOR, 8.56; 95 % CI, 1.06–69.10; P < 0.05) had higher odds of death than neonates. Conclusion. The study identified significant stewardship opportunities to improve colistin prescription and administration. Achieving optimal patient outcomes necessitates a multidisciplinary approach and vigilant monitoring of colistin use.