Colistin is relatively safe in hematological malignancies and hematopoietic stem cell transplantation patients

• Published in: Infection 2013-10, Vol.41 (5), p.991-997
• Main Authors: Averbuch, D., Horwitz, E., Strahilevitz, J., Stepensky, P., Goldschmidt, N., Gatt, M. E., Shapira, M. Y., Resnick, I. B., Engelhard, D.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Bacteremia - drug therapy; Brief Report; Child; Child, Preschool; Colistin - administration & dosage; Colistin - adverse effects; Family Medicine; Female; General Practice; Gram-Negative Bacterial Infections - drug therapy; Hematologic Neoplasms - microbiology; Hematology; Hematopoietic Stem Cell Transplantation; Humans; Infant; Infectious Diseases; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Nosocomial infection; Renal function; Retrospective Studies; Stem cells; Treatment Outcome
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-013-0471-6

Purpose Colistin is increasingly used as the last-resort treatment option against infections caused by multidrug-resistant (MDR) Gram-negative pathogens, but its nephrotoxicity is of concern, especially in severely ill patients. The aim of this study was to analyze the toxicity of colistin therapy in adults and children with hematological malignancies (HM) and hematopoietic stem cell transplantation (HSCT) recipients. Methods Data on HSCT recipients and HM patients, treated with intravenous colistin (2.5–5 mg/kg/day in children and 3–6 million international units (IU) in adults, adjusted to renal function) during the period 2008–2011 in our center, were retrospectively collected and analyzed. Nephrotoxicity was defined according to the RIFLE criteria (Risk, Injury, Failure, Loss, and End-stage kidney disease). Results Twenty-nine children and adults received 38 courses of intravenous colistin (2.5–5 mg/kg/day in children and 3–6 × 10 6  IU in adults, adjusted to renal function) [allogeneic HSCT (22 courses) and HM (16 courses)] for 3–28 days (median 10 days) for empirical therapy for nosocomial clinical sepsis (28) or local infection (6), and bacteremia with MDR Gram-negative rods (4). Nephrotoxicity was observed at the end of 4 (10.5 %) courses. In 32 (84 %) courses, nephrotoxic medications were concomitantly administered. Two patients had convulsions, probably unrelated to colistin. Seven patients (18 %) died while on colistin therapy. No death was attributed to an adverse effect of colistin. Conclusions Treatment with intravenous colistin, with dosage adjusted to renal function, was relatively safe for HM/HSCT patients, even with concomitantly administered nephrotoxic medications. Concern about nephrotoxicity should not justify a delay in initiating empirical colistin treatment in situations where infection with MDR Gram-negative rods is likely.