[The child's intestinal ecosystem: effect of colistin (author's transl)]

Area of Science:

• Microbiology
• Pediatrics
• Pharmacology

Background:

• The intestinal bacterial flora plays a crucial role in maintaining gut health.
• Understanding the normal fecal flora in hospitalized children is essential for assessing disruptions.
• Antibiotic use can significantly alter the gut microbiome.

Purpose of the Study:

• To establish the normal fecal bacterial profile in hospitalized children without infection or antibiotic treatment.
• To investigate the effects of colistin on the intestinal ecosystem in children.
• To evaluate the safety and impact of different colistin administration routes and nutritional support on fecal flora.

Main Methods:

• Differential quantitative study of fecal flora in 41 healthy hospitalized children to establish a baseline.
• Administration of colistin per os with intestinal nutrition to 21 children.
• Administration of colistin IM with gentamicin IM to 21 children.
• Administration of colistin per os with exclusive parenteral nutrition to a subset of children.

Main Results:

• Colistin per os with intestinal nutrition and colistin IM with gentamicin IM showed no significant quantitative or qualitative effects on fecal flora.
• Colistin per os with exclusive parenteral nutrition led to the disappearance of sensitive bacterial strains and overgrowth of resistant organisms.
• This disruption was associated with secondary septicemia, indicating a high infectious risk.

Conclusions:

• Oral colistin administration in children receiving exclusive parenteral nutrition poses a significant risk of secondary septicemia due to fecal flora disruption.
• It is advisable to avoid oral colistin administration in pediatric patients when the intestine is not receiving any nutritional support.
• Maintaining intestinal integrity and nutrition is critical when using antibiotics like colistin.