Use of colistin in a pediatric burn unit in Argentina

The use of sulfomethate sodium colistin for the treatment of infections caused by multiple drug resistant (MDR) Gram-negative microorganisms were studied in a burn unit to evaluate the safety of this drug. A prospective chart review of pediatric patients treated with intravenous colistin in a tertiary burn unit between January 2005 and December 2006 was performed. Forty-five courses of intravenous colistin treatment administered to 45 children were evaluated in the study period. Fourteen patients (31%) were infected by Pseudomonas aeruginosa spp and 20 patients (44.5%) by Acinetobacter spp and an association of both bacteria was found in six patients (13.5%).The mean age of the patients was 52 months (range, 2 to 168 months), and 28 patients (62%) were men. The percentage of burnt body surface was between 9 and 87% (mean, 38%). Forty patients (89%) were infected by MDR organisms. Colistin was empirically indicated in five patients (11%) with burn wound sepsis 7 days after admission to the unit despite negative cultures. Burn wound sepsis was the most frequent focus of infection in 19 patients (42%). In 14 patients (31%), burn wound infection occurred without sepsis. Intravascular catheter-related bacteremia occurred in three patients (7%) and bacteremia in one (2%). Three patients had pneumonia (7%), three osteomyelitis (7%), and two urinary tract infection (4%).The length of treatment with colistin was between 3 and 92 days (median, 21 days). Only one patient (2%) died for reasons other than infection. None of the children developed increases in serum creatinine concentrations or neurological complications during treatment with colistin. Colistin seems to be a safe drug in selected cases of infections with MDR Gram-negative microorganisms. Further studies are needed to confirm these results.