Moolla Muhammad S, Whitelaw Andrew, Decloedt Eric H, Koegelenberg Coenraad F N, Parker Arifa
Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
JAC Antimicrob Resist. 2021 Nov 17;3(4):dlab169. doi: 10.1093/jacamr/dlab169. eCollection 2021 Dec.
Colistin use is increasing with the rise in MDR Gram-negative infections globally. Effective antibiotic stewardship is essential to preserve this antibiotic of last resort.
This study investigated stewardship and safety errors related to colistin use to identify opportunities for improvement.
A prospective descriptive study involving all patients 13 years and older treated with colistin at a tertiary hospital in Cape Town, South Africa, between August 2018 and June 2019. We collected clinical, laboratory and outcome data and assessed provided treatment for stewardship and safety errors.
We included 44 patients. Treatment errors were identified for 34 (77%) patients (median = 1), most commonly inadequate monitoring of renal function (=16, 32%). We also identified no rational indication for colistin (=9, 20%), loading dose error (=12, 27%); maintenance dose error (=10, 23%); no prior culture (=11, 25%); and failure to de-escalate (2 of 9) or adjust dose to changes in renal function (6 of 15). All cause in-hospital mortality was 47%. Amongst survivors, median ICU stay was 6 days and hospital stay more than 30 days. Eight (18%) patients developed renal injury or failure during treatment. Three (7%) patients in this study were found to have colistin-resistant organisms including two prior to colistin exposure.
This study has identified opportunities to enhance colistin stewardship and improve efficacy and safety of prescription. The appearance of colistin-resistant organisms reinforces the urgent need to ensure effective and appropriate use of colistin.
随着全球耐多药革兰氏阴性菌感染的增加，黏菌素的使用也在增多。有效的抗生素管理对于保留这种最后的抗生素至关重要。
本研究调查了与黏菌素使用相关的管理和安全错误，以确定改进的机会。
一项前瞻性描述性研究，纳入了2018年8月至2019年6月期间在南非开普敦一家三级医院接受黏菌素治疗的所有13岁及以上患者。我们收集了临床、实验室和结局数据，并评估了所提供治疗中存在的管理和安全错误。
我们纳入了44例患者。34例（77%）患者被发现存在治疗错误（中位数 = 1），最常见的是肾功能监测不足（16例，32%）。我们还发现9例（20%）患者使用黏菌素无合理指征；12例（27%）患者负荷剂量错误；10例（23%）患者维持剂量错误；11例（25%）患者未进行前期培养；9例中有2例未降阶梯治疗，15例中有6例未根据肾功能变化调整剂量。全因住院死亡率为47%。在幸存者中，重症监护病房（ICU）住院时间中位数为6天，住院时间超过30天。8例（18%）患者在治疗期间出现肾损伤或肾衰竭。本研究中有3例（7%）患者被发现存在对黏菌素耐药的微生物，其中2例在接触黏菌素之前就已存在。
本研究确定了加强黏菌素管理以及提高处方疗效和安全性的机会。黏菌素耐药微生物的出现强化了确保有效和合理使用黏菌素的迫切需求。
