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Intravenous Colistin Use for Multidrug-Resistant Gram-Negative Infections in Pediatric Patients
Ayşe Karaaslan1, Eren Çağan1, Eda Kepenekli Kadayifci1
1Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey.
Background:
The emergence of infections due to multidrug-resistant Gram-negative bacilli (MDR-GNB) has led to the resurrection of colistin use. The data on colistin use and drug-related adverse effects in children are scarce.
Aims:
In this study, we aimed to evaluate the clinical efficacy and safety of colistin use in critically ill pediatric patients.
Study Design:
This study has a retrospective study design.
Methods:
Sixty-one critically ill children were identified through the department's patient files archive during the period from January 2011 to November 2014.
Results:
Twenty-nine females and thirty-two males with a mean±standard deviation (SD) age of 61±9 months (range 0-216, median 12 months) received IV colistin due to MDR-GNB infections. Bacteremia (n=23, 37.7%) was the leading diagnosis, followed by pneumonia (n=19, 31%), clinical sepsis (n=7, 11.4%), wound infection (n=6, 9.8%), urinary tract infection (n=5, 8.1%) and meningitis (n=1, 1.6%). All of the isolates were resistant to carbapenems; however, all were susceptible to colistin. The isolated microorganisms in decreasing order of frequency were: Acinetobacter baumanni (n=27, 44.2%), Pseudomonas aeruginosa (n=17, 27.8%), Klebsiella pneumoniae (n=6, 9.8%), K. pneumoniae and Stenotrophomonas maltophilia (n=1, 1.6%), K. pneumoniae and A. baumanni (n=1, 1.6%), K. oxytoca (n=1, 1.6%) and Enterobacter cloacae (n=1, 1.6%). In seven patients, no microorganisms were detected; however, five of these patients were colonized by carbapenem-resistant K. pneumoniae. The mean duration of colistin therapy was 12 days (range 3-45). Colistin was administered concomitantly with one of the following antibiotics: carbapenem (n=50, %82), ampicillin-sulbactam (n=5, 8%), quinolones (n=5, 8%), rifampicin (n=1, 1.6%). Carbapenem was the most frequently used antibiotic. Nephrotoxicity was observed in only 1 patient, and we did not observe neurotoxicity in this study. All the patients received intravenous colistin (colisthimethate) at a dosage of 5 mg/kg daily by dividing it in three equal doses. Seven (11.4%) patients died during the study period.
Conclusion:
Colistin appears to be a safe and efficacious drug for treating MDR-GNB infections in children.
Insights
Colistin is a safe and effective treatment for multidrug-resistant Gram-negative bacilli (MDR-GNB) infections in critically ill children. This study found low rates of adverse effects, supporting its use in pediatric intensive care units.
Area of Science:
- Pediatric Infectious Diseases
- Critical Care Medicine
- Antimicrobial Stewardship
Background:
- The rise of multidrug-resistant Gram-negative bacilli (MDR-GNB) necessitates exploring alternative antibiotics like colistin.
- Data on colistin's efficacy and safety in pediatric populations, especially critically ill children, remain limited.
Purpose of the Study:
- To assess the clinical effectiveness of intravenous colistin in critically ill children with MDR-GNB infections.
- To evaluate the safety profile and drug-related adverse effects of colistin therapy in this pediatric cohort.
Main Methods:
- Retrospective study design analyzing data from January 2011 to November 2014.
- Inclusion of 61 critically ill children diagnosed with MDR-GNB infections.
- Review of patient files for demographics, diagnoses, causative agents, treatment regimens, and outcomes.
Main Results:
- Colistin was effective against all tested MDR-GNB isolates, including Acinetobacter baumanni and Pseudomonas aeruginosa.
- The most common indications for colistin were bacteremia and pneumonia.
- Colistin demonstrated a favorable safety profile, with only one case of nephrotoxicity and no observed neurotoxicity.
Conclusions:
- Intravenous colistin is a safe and effective therapeutic option for treating multidrug-resistant Gram-negative bacilli infections in critically ill children.
- The findings support the continued use of colistin in pediatric critical care settings for challenging infections.
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