An Investigation on The Use of Colistin in Critically Ill Patients at A Teaching Hospital in Ho Chi Minh City

Colistin is reintroduced into therapeutic protocols as one of the last resort antibiotics against multidrug-resistant (MDR) pathogens. In February 2019, International Consensus Guidelines (ICG 2019) on optimizing administration colistin has for first time stipulated an official recommendation higher dosing regimen based pharmacokinetic/pharmacodynamic (PK/PD) modeling data. This study aimed at assessing current University Medical Center (UMC) Ho Chi Minh City (HCMC) and to identify rates risk factors colistin-induced nephrotoxicity. A cross sectional was conducted patients admitted Intensive Care Unit (ICU), being treated severe infection with least 5 days IV from April 2018 2019. KDIGO criteria were used evaluate nephrotoxicity during treatment. Colistin-resistance detected in 4 cases period. The majority (n=104, 87.4%) diagnosed pneumonia due mainly Acinetobacter baumannii. Rational according PK/PD approach, EMA, FDA observed 33 (27.8%), 39 (32,8%), 44 (38,2%), respectively. 85 (71,4%) evaluated rational accordance three guidelines. Clinical efficacy recorded 59 infected (49.6%). Lower average maintenance dose treatment failure (p = 0.002). KDIGO-defined acute kidney injury (AKI) developed 70 (58,8%). Multivariate analysis showed that concomitant vasopressors (OR 16.52; 95% CI 5.3750.83; p 0.001), furosemide 5.24; 1.89–14.55; 0.001) hypoalbuminemia (< 25 g/l) 6.24; 2.17–17.93; significantly associated Consistent previous studies, a very modest clinical cure rate high frequency AKI development colistin-resistant strains, alternative agents such new beta-lactam/beta-lactamase inhibitor combinations favourable safety data are strongly preferred carbapenem-resistant infection.