Analiza zdravljenja s kolistinom v Splošni bolnišnici Murska Sobota v letih od 2016 do 2021

Meško, Tamara (avtor), Kerec Kos, Mojca (mentor), Kovačič, Alenka (komentor)

V zadnjih letih je protimikrobna odpornost vedno bolj pogosta in predstavlja resen javnozdravstveni problem. Za zdravljenje okužb z odpornimi mikroorganizmi se uporabljajo protimikrobne učinkovine zadnjega izbora. Med te učinkovine spada tudi kolistin, ki ima ozko terapevtsko okno. Optimalno odmerjanje še ni določeno in njegova poraba v bolnišnicah se povečuje. Izvedli smo retrospektivno analizo uporabe kolistina v Splošni bolnišnici Murska Sobota od leta 2016 do vključno 2021. Analizirali smo indikacije za uporabo kolistina, odmerek in odmerni interval ter njuno ustreznost, čas trajanja terapije, pojav neželenih učinkov in nekatere parametre vnetja, izide zdravljenja ter intervencije kliničnih farmacevtov. Preverili smo tudi, kako se je trend predpisovanja spreminjal skozi leta. V raziskavo smo vključili 93 bolnikov, ki so se s kolistinom najpogosteje zdravili na oddelku za perioperativno medicino, odsek intenzivne terapije. Najpogostejša indikacija za predpis kolistina je bila pljučnica (56/93 bolnikov). Najpogostejša povzročitelja sta bila Acinetobacter baumannii in Pseudomonas aeruginosa. Terapija s kolistinom je bila glede na mikrobiološki izvid upravičena v 73,9 % vseh zdravljenj. V 43 % primerih je bolnik ob uvedbi terapije dobil polnilni odmerek. Najpogosteje so bolniki prejemali vzdrževalni odmerek 3 mi.e./8h (39 bolnikov) oz. 4,5 mi.e./12h (15 bolnikov). Farmacevt je odmerek na naročilnici za protimikrobna rezervna zdravila popravil v 63 primerih in popravek je bil upoštevan v 82,5 % primerov. Za 35 naročilnic je bil napisan tudi izvid farmacevta. Ocenili smo, da se je med terapijo pri 27 bolnikih (33,8 %) razvila akutna ledvična okvara. Zdravljenje s kolistinom je bilo uspešno pri 37,6 % bolnikov, pri 32,2 % smo zdravljenje ocenili kot neuspešno, v 30,1 % primerov pa izida zdravljenja ni bilo mogoče oceniti. Bolniki, pri katerih je bilo zdravljenje uspešno, so bili značilno mlajši ter pri njih je bilo značilno manj intervencij farmacevta, vezanih na zdravljenje s kolistinom. V ostalih parametrih se skupini nista statistično pomembno raziskovali. Uporaba kolistina v letih 2016-2021 v Splošni bolnišnici Murska Sobota narašča. Predvsem je opazen dvig porabe v letu 2021, a predvsem na račun zdravljenja bolnikov z okužbo COVID-19.

• Jezik: Slovenski jezik
• Ključne besede: kolistin, naročilnica za protimikrobna rezervna zdravila, neželeni učinki, uspešnost zdravljenja
• Vrsta gradiva: Magistrsko delo/naloga
• Organizacija: FFA - Fakulteta za farmacijo
• Leto izida: 2023
• PID: 20.500.12556/RUL-146804
• Datum objave v RUL: 14.06.2023

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Analysis of treatment with colistin at the General Hospital Murska Sobota in the years 2016 to 2021

Izvleček

In recent years, antimicrobial resistance has become increasingly common and represents serious public health problem. For the treatment of infections with multidrug-resistant microorganisms, last-line antimicrobial drugs are used. Colistin is one such drug, with a narrow therapeutic window. Optimal dosing of colistin has not yet been determined and its use in hospitals is increasing. We performed a retrospective analysis of colistin use in the General Hospital Murska Sobota in years 2016 to 2021. We analysed indications for colistin use, doses and dosing intervals, their appropriateness, duration of therapy, the occurrence of adverse drug reactions, selected inflammatory parameters, treatment outcomes, and interventions by clinical pharmacists. We also checked how the prescribing trend changed over the years. We included 93 patients in the study. Colistin treatment was most commonly prescribed to patients in the perioperative medicine department, intensive care unit. The most common indication for prescribing colistin was pneumonia (56/93 patients). The most common causative agents were Acinetobacter baumannii and Pseudomonas aeruginosa. Therapy with colistin was justified based on microbiological results in 73.9 % of all treatments. In 43 % of cases, the patient received a loading dose upon initiation of therapy. The most common maintenance dose was 3 mi.e./8h (39 patients) or 4.5 mi.e./12h (15 patients). The pharmacist corrected the dose on the antimicrobial reserve drug order form in 63 cases and also wrote a pharmacist's report for 35 orders. The pharmacist's correction was accepted by the physicians in 82.5 %. We estimated that acute kidney injury developed during therapy in 27 (33.8 %) patients. Treatment was successful in 37.6 % of patients, and we considered treatment to be unsuccessful in 32.2 % of cases, the outcome of treatment could not be evaluated in 30.1 % of cases. Patients with successful treatment were significantly younger, and fewer pharmacist interventions related to colistin treatment were observed in this group. There were no statistically significant differences between the groups in other parameters analysed. The use of colistin in the General Hospital of Murska Sobota is increasing from 2016 to 2021, especially in 2021, when the highest number of COVID-19 patients were treated.

• Ključne besede: colistin, prescription form for reserve antimicrobal drugs, adverse effects, treatment success