Intravenous Colistin for the Treatment of Multi-Drug Resistant, Gram-Negative Infection in the Pediatric Burn Population

Abstract

The rising incidence of multi-drug resistant (MDR) gram-negative infections in the intensive care unit (ICU) continues to challenge clinicians and has resulted in reemergence of the glycopeptide antibiotic colistin. Over the past 11 years, 14 patients at a tertiary pediatric burn center were treated with colistin for gram-negative infections resistant to all tested antibiotics. This study reviews the safety of such treatment and the outcome for this cohort of patients. All hospitalized patients treated with intravenous colistin between 1990 and 2005 were identified. A retrospective chart review was performed for each patient. Demographic data, along with information regarding the type and severity of injury, were collected. Data with respect to microbiology, renal status, and neurological events were also noted. Over an 11-year period, we identified 14 children infected with pan-resistant gram-negative organisms requiring 16 courses of colistin. Two children (14.3%) developed significant rises in serum creatinine concentration; however, no child required renal replacement therapy or developed neurologic complications attributable to colistin. Favorable response rate was 78.6% (11/14), and overall mortality was 14.3% (2/14); both deaths were attributed to sepsis. In our experience with 14 children treated with intravenous colistin, two developed a significant elevation in serum creatinine concentration during the course of therapy and neurotoxicity was not reported. Colistin should be dispensed with great caution, but it appears to have an acceptable safety profile in children and may be used in select cases of infection with highly resistant gram-negative organisms.

Infecciones en los niños quemados: análisis epidemiológico y de los factores de riesgo

“…Sin embargo, no documentamos tales efectos en nuestros pacientes. 24,25 El uso de antimicrobianos locales está muy difundido, pero su eficacia es un punto de debate 26 y aparece como un factor de riesgo no independiente de infección de esta serie.…”

Acinetobacter baumannii : Emergence of a Successful Pathogen

“…Overall, the efficacy of the drug has been highly encouraging in both adult and pediatric populations, with favorable or curative responses ranging from 57% to Ͼ80% (158,185,207,241,283,301,327,357,369,409,451,517). In several recent prospective cohort studies across a range of infection types, the outcomes for patients receiving definitive therapy with colistin for colistin-only-susceptible organisms were similar to those for patients receiving combinations of other antibiotics (predominantly carbapenems with or without other antibiotics) for more susceptible organisms (185,451).…”

Population Pharmacokinetic Analysis of Colistin in Burn Patients

“…Severely burned patients are extremely vulnerable to these kinds of infections because they are hospitalized in the ICUs and their physiologic defense mechanisms, such as their integumentary systems and immunologic responses, are impaired (8,9,10). Therefore, colistin is now considered an important treatment option for burn patients with bacterial infections (11). Recent studies on polymyxins such as colistin have led to the conclusion that these antibiotics are acceptably effective and less toxic than was previously thought (1).…”