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

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Abstract

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 × 106 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.

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Acknowledgments

There was no financial support for this study in any form, including grants, equipment, or drugs.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

The study was approved by the Hadassah-Hebrew University Medical Center institutional ethics committee.

Author information

Authors and Affiliations

  1. Pediatric Infectious Disease Unit, Hadassah-Hebrew University Medical Center, 91120, Ein Kerem, Jerusalem, Israel

    D. Averbuch & D. Engelhard

  2. Pharmacy Division, Hadassah-Hebrew University Medical Center, 91120, Ein Kerem, Jerusalem, Israel

    E. Horwitz

  3. Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, 91120, Ein Kerem, Jerusalem, Israel

    J. Strahilevitz

  4. Pediatric Hemato-Oncology Department, Hadassah-Hebrew University Medical Center, 91120, Ein Kerem, Jerusalem, Israel

    P. Stepensky

  5. Hematology Department, Hadassah-Hebrew University Medical Center, 91120, Ein Kerem, Jerusalem, Israel

    N. Goldschmidt & M. E. Gatt

  6. Bone Marrow Transplantation Department, Hadassah-Hebrew University Medical Center, 91120, Ein Kerem, Jerusalem, Israel

    M. Y. Shapira & I. B. Resnick

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  1. D. Averbuch
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  2. E. Horwitz
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Correspondence to D. Averbuch.

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Averbuch, D., Horwitz, E., Strahilevitz, J. et al. Colistin is relatively safe in hematological malignancies and hematopoietic stem cell transplantation patients. Infection 41, 991–997 (2013). https://doi.org/10.1007/s15010-013-0471-6

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  • DOI: https://doi.org/10.1007/s15010-013-0471-6

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