| DOI: https://doi.org/10.29090/psa.2018.01.037 | Pharm Sci Asia 2018; 45(1), 37-44 |
Investigation on colistin use at the University Medical Center Hochiminh CityT.C. Bang, D.N.D. Trang
1 Department of Clinical Pharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy, Hochiminh City, Vietnam
2 Department of Pharmacy, University Medical Center Hochiminh City, University of Medicine and Pharmacy, Hochiminh City, Vietnam
The upsurge of multi-resistant gram-negative pathogen highlights the role of colistin as the last-line antimicrobial agent in the treatment of severe infections all over the world. Recently, the increase of colistin use at University Medical Center Hochiminh City (UMC) has raised the concern about the potential resistance of microbes against this antibiotic. The aim of this study is to evaluate rational colistin indication and to identify factors which may be attributed to nephrotoxicity. One hundred and two in-patients indicated with colistin for 72 hours or more from January to December 2016 were enrolled in a descriptive cross-sectional study at University Medical Center HCMC. Medical records of patients were reviewed for data analysis. Risk, Injury, Failure, Loss of kidney function, and End-stage kidney diseases (RIFLE) criteria was used to evaluate nephrotoxicity during treatment. The median age of the study population was 77.5, 64.7% were male and 63 patients (61.8%) were treated in the ICU. The most common comorbidities were cardiovascular diseases (70.6%). Acinetobacter baumannii accounted for 35.76% of 4 common pathogens but no resistance to colistin was found during the study period. The average daily colistin dose per kilogram was 97,26 ± 35,21 IU and the average duration of intravenous colistin was 13.05 ± 6.67 days. Rational use of colistin was observed in only 32.8% of the study population. Twelve patients (11.76%) experienced nephrotoxicity after the course of treatment using RIFLE criteria. Logistic regression analysis showed that age (OR = 1.059; 95% CI 1.020-1.087, p = 0.004), respiratory diseases (OR = 0.139; 95% CI 0.024-0.804, p = 0.028), concomitant use with furosemide (OR = 6,215; 95% CI 1.002-38.565, p = 0.049) or amphotericin B (OR = 29.995; 95% CI 2.638-341.007, p = 0.006) were significantly associated with nephrotoxicity
Keyword:
Colistin; Resistance; Rational use; Nephrotoxicity
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