Efficacy of Colistin Therapy in Patients with Hematological Malignancies: What if There is Colistin Resistance?


Abstract views: 227 / PDF downloads: 172

Authors

DOI:

https://doi.org/10.58600/eurjther-340

Keywords:

Colistin, hematological malignancy, empirical treatment, carbapenem resistance, colistin resistance

Abstract

Objective: The objective of this study was to evaluate the clinical efficacy and appropriateness of colistin therapy in patients with hematological malignancies.

Methods: Age, gender, type of hematologic malignancy, and potential carbapenem-resistant microorganism risk factors were all noted in this retrospective study. In empirical and agent-specific treatment groups, differences in demographic features, risk factors, treatment responses, and side effects were compared.

Results: Sixty-three patients were included, 54% were male, and the median age was 49. In the last three months, the hospitalization rate history was 68%, and four patients had a hospitalization history in the ICU. Carbapenem-resistant K. pneumoniae colonization was present in 22 patients (35%). Gram-negative microorganisms were isolated in 34 patients (54%). The carbapenem, quinolone, and colistin resistance rates were 82%, 76%, and 4% respectively. Clinical and microbiological response rates were 60% and 69%. 7 and 28-day mortality rates were 17% and 35%. There was no significant difference in demographic data and comorbidities in empirical (n=48) and agent-specific (n=15) treatment groups. The rate of carbapenem and glycopeptide treatments before colistin was higher in the empirical treatment group (p = 0.004; p = 0.001). The rate of starting combined antibiotics was higher in
the empirical treatment group (p = 0.016). Two of the patients developed renal failure in the first week after treatment.

Conclusion: The use of empirical colistin may be unavoidable given the risk considerations. Shortly, colistin-resistant strains may also be a factor affecting treatment success negatively.

Metrics

Metrics Loading ...

References

Averbuch D, Horwitz E, Strahilevitz J, Stepensky P, Goldschmidt N, Gatt ME, et al. Colistin is relatively safe in hematological malignancies and hematopoietic stem cell transplantation patients.Infection. 2013;41(5):991-7.

Wang X, Zhang L, Sun A, Yang X, Sang W, Jiang Y, et al. Acinetobacter baumannii bacteraemia in patients with haematological malignancy:a multicentre retrospective study fromthe Infection Working Party of Jiangsu Society of Hematology. Eur J ClinMicrobiol Infect Dis. 2017;36(7):1073-1081.

Pohlen M, Marx J, Mellmann A, Becker K, Mesters RM, Mikesch JH, et al. Ciprofloxacin versus colistin prophylaxis during neutropenia in acute myeloid leukemia: two parallel patient cohorts treated in a single center. Haematologica. 2016 Oct;101(10):1208-1215.

Kaskatepe B, Yildiz SS, Mumcuoglu I, Ozet G, Altuntas EG. RS sample: Can be guide for empirical treatment of haematological malignancy patients? MicrobPathog. 2018;125:164-167.

Kokkayil P, Agarwal R, Mohapatra S, Bakshi S, Das B, Sood S. Bacterial profile and antibiogram of blood stream infections in febrile neutropenic patients with haematological malignancies. J Infect Dev Ctries. 2018;12(6):442-447.

Zavascki AP, Girardello R, Magagnin CM, Antochevis LC, Maciel RA, Palmeiro JK, et al. Emergence of polymyxin B resistance in a polymyxin B-susceptible KPC-producing Klebsiella pneumoniae causing bloodstream infection in a neutropenic patient during polymyxin B therapy. DiagnMicrobiol Infect Dis. 2018;90(2):134-138.

Pormohammad A, Mehdinejadiani K, Gholizadeh P, Nasiri MJ, Mohtavinejad N, Dadashi M, et al. Global prevalence of colistin resistance in clinical isolates of Acinetobacter baumannii: A systematic review and meta-analysis. Microb Pathog. 2020;139:103887.

Zafer MM, El-Mahallawy HA, Abdulhak A, Amin MA, Al-Agamy MH, Radwan HH. Emergence of colistin resistance in multidrug-resistant Klebsiella pneumoniae and Escherichia coli strains isolated from cancer patients. Ann Clin Microbiol Antimicrob. 2019 Dec 12;18(1):40. doi: 10.1186/s12941-019-0339-4.

Ghosh S, Chakraborty M, Samanta S, Sinha N, Saha S, Chattopadhyay A, et al. of blood stream infections, antibiograms and clinical outcomes in haematological patients with febrile neutropenia: data from a tertiary care haematology institute in India. Ann Hematol. 2020 Nov 2. doi: 10.1007/s00277-020-04324-8. Epub ahead of print.

Liu P, Li X, Luo M, Xu X, Su K, Chen S, et al. Rish factors for Carbapenem-Resistant Klebsiella pneumoniae Infection: A Meta-Analysis. Microb Drug Resist. 2018;24(2):190-198. doi: 10.1089/mdr.2017.0061. Epub 2017 Jul 27

Liu J, Wang H, Huang Z, Tao X, Li J, Hu Y, et al. Risk factors and outcomes for carbapenem-resistant Klebsiella pneumoniae bacteremia in onco-hematological patients. J Infect Dev Ctries. 2019;13(5):357-364. doi: 10.3855/jidc.11189.

Dickstein Y, Lellouche J, Ben Dalak Amar M, Schwartz D, Nutman A, Daitch V et al; AIDA Study Group. Treatment Outcomes of Colistin- and Carbapenem-resistant Acinetobacter baumannii Infections: An Exploratory Subgroup Analysis of a Randomized Clinical Trial. Clin Infect Dis. 2019;69(5):769-776. doi: 10.1093/cid/ciy988

Papadimitriou-Olivgeris M, Fligou F, Spiliopoulou A, Koutsileou K, Kolonitsiou F, Spyropoulou A, et al. Risk factors and predictors of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii mortality in critically ill bacteraemic patients over a 6-year period (2010-15): antibiotics do matter. J Med Microbiol. 2017;66(8):1092-1101. doi: 10.1099/jmm.0.000538.

Zarkotou O, Pournaras S, Voulgari E, Chrysos G, Prekates A, Voutsinas D, et al. Risk factors and outcomes associated with acquisition of colistin-resistant KPC-producing Klebsiella pneumoniae: a matched case-control study. J Clin Microbiol. 2010;48(6):2271-4. doi: 10.1128/JCM.02301-09. Epub 2010 Apr 7.

Metan G, Demiraslan H, Kaynar LG, Zararsız G, Alp E, Eser B. Factors influencing the early mortality in haematological malignancy patients with nosocomial Gram negative bacilli bacteraemia: a retrospective analysis of 154 cases. Braz J Infect Dis. 2013;17(2):143-9. doi: 10.1016/j.bjid.2012.09.010.

Metan G, Pala Ç, Kaynar L, Cevahir F, Alp E. A nightmare for haematology clinics: extensively drug-resistant (XDR) Acinetobacter baumannnii. Infez Med. 2014;22(4):277-82.

Sertcelik A, Baran I, Akinci E, Mumcuoglu I, Bodur H. Synergistic Activities of Colistin Combinations with Meropenem, Sulbactam, Minocycline, Disodium Fosfomycin, or Vancomycin Against Different Clones of Carbapenem-Resistant Acinetobacter baumannii Strains. Microb Drug Resist. 2020;26(5):429-433. doi: 10.1089/mdr.2019.0088.

Bae S, Kim MC, Park SJ, Kim HS, Sung H, Kim MN, et al. In Vitro Synergistic Activity of Antimicrobial Agents in Combination against Clinical Isolates of Colistin-Resistant Acinetobacter baumannii. Antimicrob Agents Chemother. 2016;60(11):6774-6779. doi: 10.1128/AAC.00839-16.

Durakovic N, Radojcic V, Boban A, Mrsic M, Sertic D, Serventi-Seiwerth R, et al. Efficacy and safety of colistin in the treatment of infections caused by multidrug-resistant Pseudomonas aeruginosa in patients with hematologic malignancy: a matched pair analysis. Intern Med. 2011;50(9):1009-13. doi: 10.2169/internalmedicine.50.4270. Epub 2011 May 1

Downloads

Published

2023-03-30

How to Cite

Ture, Z., Unüvar, G. K., Kahveci, H. N., Keklik, M., & Kilic, A. U. (2023). Efficacy of Colistin Therapy in Patients with Hematological Malignancies: What if There is Colistin Resistance?. European Journal of Therapeutics, 29(1), 17–22. https://doi.org/10.58600/eurjther-340

Issue

Section

Original Articles