Effectiveness and safety of colistin among older adults: a systematic review and meta-analysis

Abstract

Objectives Limited data are available to guide colistin use in older adults (>65 years old). We aimed to assess the effectiveness and safety of colistin in this population. Methods Systematic review and meta-analysis of original data from randomized control trials, cohort studies and case–control studies assessing colistin regimens with various comparisons for any infection. Original data were obtained from corresponding authors of original studies. The primary outcome was all-cause 1 month mortality; secondary outcomes included clinical and microbiological outcomes and adverse events, including acute kidney injury. Two independent reviewers screened citations, extracted data and assessed risk of bias. ORs with 95% CIs were pooled. Results We included 38 publications (41 comparisons) reporting 2857 elderly individuals: 29 studies compared a colistin-based regimen versus another regimen (comparison 1) and 10 compared colistin monotherapy versus colistin combination (comparison 2). No significant difference in 1 month mortality was demonstrated between colistin and comparator (comparison 1, OR 1.13, 95% CI 0.80–1.60; comparison 2, OR 0.99, 95% CI 0.78–1.27). Clinical failure was significantly more likely with colistin-based therapy versus comparator (OR 1.52, 95% CI 1.13–2.06). Acute kidney injury was also significantly more common with colistin-based combinations versus other drugs (OR 3.81, 95% CI 2.14–6.77). Conclusions For older adults, colistin-based therapy resulted in no mortality difference, compared with other regimens, for any infection. Clinical failure and acute kidney injury were significantly more common with colistin-based regimens. Close renal function monitoring is needed while using colistin in older adults.

Colistin monotherapy or combination for the treatment of bloodstream infection caused by Klebsiella pneumoniae: a systematic review and meta-analysis

“…According to a systematic review and meta-analysis by Zusman, 2016, included 7 observational studies for Klebsiella pneumoniae bacteremia, polymyxins (polymyxinB, colistin) monotherapy was associated with an OR of 2.09 (95% = 1.21–3.60) for mortality compared with combination therapy with tigecycline [ 18 ]. Recently, to assess the effectiveness and safety of colistin among older adults, a study by Margalit included 38 publications (41 comparisons) reported 2857 elderly individuals in 2022, which demonstrated colistin-based therapy resulted in no mortality difference, compared with other regimens, for any infection [ 19 ].…”

Biomarkers for risk stratification and antibiotic stewardship in elderly patients

“…Similar findings are available for colistin. A recent metanalysis including 2857 elderly with MDRO infections showed that acute kidney injury was significantly more common in patients who received colistin versus other drugs [ 49 ]. In addition, not only the type of antibiotics, but also the duration of antibiotic therapy plays an important role in the outcome of elderly patients.…”

Heteroresistance to colistin in wild-type Klebsiella pneumoniae isolates from clinical origin

“…Polymyxin B and colistin (polymyxin E) were approved for clinical use in the late 1950s but fell out of favor during the mid-1970s owing to concerns over their potential to cause nephrotoxicity and neurotoxicity. More recently, polymyxins have been reconsidered as useful therapeutic agents for the treatment of infections caused by multiresistant gram-negative bacteria ( 1 – 3 ).…”