Publication: Intravenous colistin use in children: Single-center experience
Abstract
Amaç: Bakterisidal bir antibiyotik olan kolistin 1960 öncesinde gram negatif bakterilerin yol açtığı enfeksiyonların tedavisinde kullanılmıştır. 1980li yıllarda yan etkileri nedeniyle ve daha güvenli ilaçların bulunması ile birlikte kullanımı terk edilmiştir. Klinikte çoklu ilaç dirençli gram-negatif bakteriler (ÇİDGNB) (özellikle Pseudomonas spp. ve Acinetobacter spp.) ile oluşan infeksiyonlarda ve özellikle de kolistin dışındaki diğer antibiyotiklere direnç varlığında kullanılması önerilmektedir. Nefrotoksisite kolistinin intravenöz (İV) verilmesi sonrası en fazla ortaya çıkan yan etkidir. Nefrotoksisite doz bağımlıdır ve geri dönüşümlüdür. Bu çalışmanın amacı çocuklarda ve yenidoğanlarda ÇİDGNB ile meydana gelen enfeksiyonlarda kolistin etkinliğini ve güvenliğini değerlendirmektir. Gereç ve Yöntemler: İnhaler tedaviler hariç İV kolistin tedavisi verilen 18 yaş altı tüm hastaların dosyaları retrospektif olarak incelenmiştir. Hastaların demogra- fik verileri, sistemik enfeksiyon için risk faktörleri, etken mikroorganizmalar ve duyarlılıkları, kolistin yan etkileri açısından değerlendirilmiştir Bulgular: Kriterleri karşılayan 23 hasta çalışmaya alındı. Ortanca yaş ikiydi (4 gün-17 yaş). Kolistin %78,2 (18/23) Çoklu ilaç dirençli (ÇİD) Acinetobacter baumanii, %21,8 (5/23) ise ÇİD Pseudomonas aeuroginosa enfeksiyonlarına karşı kullanıldı. ÇİD A. baumanii 15 hastada kan kültüründe, birer hastada ise idrar, yara ve solunum örneği kültürlerinde üredi. ÇİD P. aeuroginosa ise dört hastada solunum örneklerinde, bir hastada ise kan kültüründe üredi. Kolistin tedavi süresinin ortanca değeri 13 (4-30) gündü. Tüm hastalara kolistin yanında ek antibiyotik verildi. En fazla verilen antibiyotik karbapenemler iken (13 hasta), beş hastaya sulbaktam-ampisilin, dört hastaya siprofloksasin, üç hastaya da aminoglikozid tedavileri verildi. Bir hasta kolistin tedavisi sırasında kaybedildi. Hiçbir hastada nefrotoksisite ve nörotoksisite gelişmedi. Sonuç: Çocuk hastalarda ÇİDGNB enfeksiyonlarının tedavisinde İV kolistin kullanımı etkili ve güvenli görünmektedir.
Objective: Colistin, a bactericidal antibiotic, was used in the 1960s for the treatment of infections by gram-negative bacteria. Because of its side effects and the development of safer drugs, its use was abandoned in the 1980s. In infections within clinics where multi-drugresistant gram-negative bacteria (MDRGNB) (especially Pseudomonas spp. and Acinetobacter spp.) are present, colistin usage is suggested if there is drug resistance to any other antibiotics. Nephrotoxicity is one of the commonly observed adverse effects following intravenous (IV) administration of colistin. Nephrotoxicity is dose-dependent and reversible. The aim of this study is to evaluate the efficacy and safety of colistin in MDRGNB infections occurring in pediatric and neonatal patients. Material and Methods: The files of all patients under the age of 18 who were given IV colistin treatment, apart from inhaler treatments, were retrospectively investigated. Demographic characteristics of patients, risk factors for systemic infection, causative microorganisms, and susceptibilities and side effects of colistin were evaluated. Results: Twenty-three patients meeting the criteria were included in the study. The median age was 2 years (4 days-17 years). Colistin was used for infections caused by MDR Acinetobacter baumannii 78.2% (18/23) and MDR Pseudomonas aeruginosa 21.8% (5/23). MDR A. baumannii was found growing in the blood cultures of 15 patients and in the urine, wound, and respiratory sample of 1 patient. MDR P. aeruginosa was found in respiratory samples of 4 patients and the blood culture of 1 patient. The duration of treatment with colistin was a median of 13 (4-30) days. All patients were given additional antibiotics with colistin. The most commonly used antibiotics were carbapenems (13 patients), with 5 patients given sulbactamampicillin, 4 given ciprofloxacin, and 3 given aminogly- coside. One patient died during treatment with colistin. No patient developed nephrotoxicity or neurotoxicity. Conclusion: It appears that IV colistin use is effective and safe for MDRGNB treatment in pediatric patients.
Objective: Colistin, a bactericidal antibiotic, was used in the 1960s for the treatment of infections by gram-negative bacteria. Because of its side effects and the development of safer drugs, its use was abandoned in the 1980s. In infections within clinics where multi-drugresistant gram-negative bacteria (MDRGNB) (especially Pseudomonas spp. and Acinetobacter spp.) are present, colistin usage is suggested if there is drug resistance to any other antibiotics. Nephrotoxicity is one of the commonly observed adverse effects following intravenous (IV) administration of colistin. Nephrotoxicity is dose-dependent and reversible. The aim of this study is to evaluate the efficacy and safety of colistin in MDRGNB infections occurring in pediatric and neonatal patients. Material and Methods: The files of all patients under the age of 18 who were given IV colistin treatment, apart from inhaler treatments, were retrospectively investigated. Demographic characteristics of patients, risk factors for systemic infection, causative microorganisms, and susceptibilities and side effects of colistin were evaluated. Results: Twenty-three patients meeting the criteria were included in the study. The median age was 2 years (4 days-17 years). Colistin was used for infections caused by MDR Acinetobacter baumannii 78.2% (18/23) and MDR Pseudomonas aeruginosa 21.8% (5/23). MDR A. baumannii was found growing in the blood cultures of 15 patients and in the urine, wound, and respiratory sample of 1 patient. MDR P. aeruginosa was found in respiratory samples of 4 patients and the blood culture of 1 patient. The duration of treatment with colistin was a median of 13 (4-30) days. All patients were given additional antibiotics with colistin. The most commonly used antibiotics were carbapenems (13 patients), with 5 patients given sulbactamampicillin, 4 given ciprofloxacin, and 3 given aminogly- coside. One patient died during treatment with colistin. No patient developed nephrotoxicity or neurotoxicity. Conclusion: It appears that IV colistin use is effective and safe for MDRGNB treatment in pediatric patients.