ISSN : 2146-3123
E-ISSN : 2146-3131

Intravenous Colistin Use for Multidrug-Resistant Gram-Negative Infections in Pediatric Patients
Ayşe Karaaslan 1, Eren Çağan 2, Eda Kepenekli Kadayifci 2, Serkan Atıcı 1, Gülşen Akkoç 1, Nurhayat Yakut 1, Sevliya Öcal Demir 2, Ahmet Soysal 3, Mustafa Bakır 3
1Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey
2Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey
3Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey
DOI : 10.5152/balkanmedj.2016.16210
Pages : 627-632

Abstract

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.

Keywords : Colistin, multidrug-resistant gram-negative infections, children
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