Colistin Treatment for Multidrug-Resistant Gram-Negative Infections in Children: Caution Required for Nephrotoxicity

Abstract

Objectives Colistin has come to the fore as a treatment option, especially with the occurrence of multidrug-resistant Gram-negative infections across the world. However, the high nephrotoxic effects of colistin should be taken into consideration in children. The study’s primary outcome was to determine the clinical success of the colistin treatment, and the secondary outcome was to detect the side effects related to colistin. Methods The patients who received intravenous colistin in our hospital’s last 5 years were included in the study. In addition to the patients’ demographic and clinical characteristics, the clinical success of the colistin treatment, 28-day infection-related mortality of the patients, and side effects of colistin were recorded. Results A total of 37 patients received colistin therapy during 2015–2019. Four of these patients had colistin treatment twice a year, so we accepted them as separate cases in each infection attack. Therefore, 41 cases were included in the study. The median age of the cases was 26 months (IQR: 4.50–144.50) and 27 (65.9%) were male. Twenty-seven cases (65.9%) had sepsis. The median dose of colistin was 4.2 (IQR: 3–5) mg/kg/day. Among 44 cultures obtained from the patients, the most common microorganism was Acinetobacter baumannii, with 58.5%. The clinical success was detected in 18 patients (43.9%). While overall nephrotoxicity developed in 14 (34.1%) patients, only two of them needed dialysis. Conclusion Colistin should not be considered the first choice in treating Gram-negative infections but should be kept as salvage therapy in multidrug-resistant Gram-negative infections across the world. During the treatment process, close monitoring of renal function tests and urinary output were recommended due to the risk of developing nephrotoxicity.

Use of Ceftazidime-Avibactam for Suspected or Confirmed Carbapenem-Resistant Organisms in Children: A Retrospective Study

“… 30 , 31 The all-cause 30-day mortality rate in our study was 20.0%, which is comparable to that of a recently published retrospective study that included 21 children with hematologic malignancies infected with a carbapenem-resistant gram-negative organism and treated with ceftazidime-avibactam, and reported an overall mortality rate of 20%. 23 However, the mortality rate of children infected with multidrug-resistant gram-negative organisms and treated with polymyxins in several retrospective reports fluctuated between approximately 30% and 40%, 31–33 which is higher than that observed in our study.…”

Clinical Reflections of Acinetobacter Infections in Children in a Quaternary-Care Hospital: A Five-Year Single-Center Experience

“…It has been reported that less nephrotoxicity is seen in critically ill children than adults due to the use of colistin. 14 However, clinicians should be careful because of the increasing use of polymyxins in critically ill patients and cases of resistance to this agent.…”

Insight into Antibiotic Synergy Combinations for Eliminating Colistin Heteroresistant Klebsiella pneumoniae

“…pneumoniae is one of the most clinically significant Gram-negative bacteria that causes both community-and hospital-acquired infections, and it is associated with high mortality rates owing to its globally increasing resistance rates to multiple currently available antibiotics including carbapenems [1]. Currently, colistin treatment is considered as a salvage therapy for patients infected with multi-drug-resistant (MDR) Gram-negative bacteria such as K. pneumoniae [2]. MDR is defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories [3].…”