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J Infect Chemother. 2018 May;24(5):370-375. doi: 10.1016/j.jiac.2017.12.017. Epub 2018 Feb 1.

The evaluation of safety and efficacy of colistin use in pediatric intensive care unit: Results from two reference hospitals and review of literature.

Author information

1
Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Bornova/Izmir, 35040, Turkey. Electronic address: z.sahbudak@gmail.com.
2
Division of Intensive Care Unit, Department of Pediatrics, Tepecik Training and Research Hospital, Izmir, Turkey. Electronic address: fulyakamit@yahoo.co.uk.
3
Medical School of Ege University, Division of Intensive Care Unit, Department of Pediatrics, Izmir, Turkey. Electronic address: pinar.yazici@ege.edu.tr.
4
Division of Intensive Care Unit, Department of Pediatrics, Medical School of Katip Celebi University, Izmir, Turkey. Electronic address: aysebernaanil@hotmail.com.
5
Medical School of Ege University, Division of Intensive Care Unit, Department of Pediatrics, Izmir, Turkey. Electronic address: muhterem.duyu@ege.edu.tr.
6
Division of Infectious Diseases, Department of Pediatrics, Medical School of Katip Celebi University, Izmir, Turkey.
7
Clinical Microbiology and Infectious Diseases, Tepecik Training and Research Hospital, Izmir, Turkey. Electronic address: niseloz@yahoo.com.
8
Medical School of Ege University, Department of Microbiology and Infectious Diseases, Izmir, Turkey. Electronic address: ferihacilli@yahoo.com.
9
Medical School of Ege University, Division of Intensive Care Unit, Department of Pediatrics, Izmir, Turkey. Electronic address: bulent.karapinar@ege.edu.tr.

Abstract

Colistin, an old cationic polypeptide antibiotic, have been reused due to rising incidence of infections caused by multi-drug resistant (MDR) Gram-negative microorganisms and the lack of new antibiotics. Therefore, we evaluated safety and efficacy of colistin in treatment of these infections. This study included 104 critically ill children with a median age of 55,9 months between January 2011 and January 2016. Nephrotoxicity occurred in 11 (10.5%) patients. Nephrotoxicity occurred between the third and seventh day of treatment in 63% of colistin induced nephrotoxicity episodes. The subgroup analysis between the patients who developed nephrotoxicity during colistin treatment and those that did not, showed no significant difference in terms of age, underlying disease, cause for PICU admission and type of infection required colistin treatment, P values were 0.615, 0.762, 0.621, 0.803, respectively. All patients were receiving a concomitant nephrotoxic agent (P = 0,355). The majority of the patients (52%) were having primary or secondary immune deficiency in treatment failure group and the most common cause of PICU admission was sepsis in treatment failure group, P values were 0.007 and 0.045, respectively. Mortality attributed to colistin failure and crude mortality were 14.4% and 29.8%, respectively. In conclusion, colistin may have a role in the treatment of infections caused by multidrug-resistant Gram-negative bacteria in critically ill children. However, the patients have to be followed for side effects throughout colistin treatment, not for only early stage. And the clinicians should be aware of increase in the rate of nephrotoxicity in patients those have been receiving a concomitant nephrotoxic agent.

KEYWORDS:

Carbapenem-resistant gram-negative bacteria; Child; Colistin; Critical care

PMID:
29361414
DOI:
10.1016/j.jiac.2017.12.017
[Indexed for MEDLINE]

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