Safety and efficacy of intravenous colistin use for the treatment of nosocomial multidrug-resistant Acinetobacter baumannii infections in a pediatric intensive care unit

İşgüder, Rana; Ağın, Hasan; Ceylan, Gökhan; Bayram, Nuri; Devrim, İlker

doi:10.1016/j.ajic.2015.12.028

Cited by 7 publications

(5 citation statements)

References 5 publications

(12 reference statements)

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“…The major side effects of treatment with colistin tend to be neurotoxicity and nephrotoxicity. Previous studies have observed nephrotoxicity at a rate of 0% and 12.5% (17,(27)(28)(29)(30). Seven (8.5%) patients in our study developed nephrotoxicity.…”

Section: Discussionsupporting

confidence: 55%

The effect of aminoglycosides on colistin-containing regimens in the treatment of carbapenem resistant gram-negative infections in pediatric intensive care units: a two-center experience

Bal¹

2019

Erciyes Med J

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Objective: This study aimed to assess the outcomes including morbidity and mortality of carbapenem-resistant gram-negative (CRGN) infections in pediatric critical care setting. The second aim was to investigate the impact of aminoglycosides on colistin-containing regimen in CRGN-infected pediatric critical care patients. Materials and Methods: We retrospectively evaluated medical records of 82 patients who had received colistin in combination with an aminoglycoside (CA group) or another antibiotic (CO group) at two reference pediatric intensive care units (PICUs) between February 2011 and February 2016. Results: We enrolled 82 CRGN-infected patients who were admitted to PICUs of two hospitals. The median age of the patients was 24 (25 th-75 th percentile; 8-78.75) months, and the median duration of hospital stay was 30 days (25 th-75 th percentile; 16.7-57.7). No statistical difference was observed in the variables, including microbiological response, attributable mortality, crude mortality, and the duration of achieving first negative culture (p>0.05). Clinical response was significantly more observed in the CA group (85.5% vs. 63.2; p=0.048), and attributable mortality was higher in the CO group (12.7% vs. 31.6%; p=0.055). Nephrotoxicity did not show statistical difference between groups (p=0.357), and neurotoxicity was not observed. Conclusion: Colistin-containing regimen in combination with an aminoglycoside may be an effective and safe antimicrobial agent without a significant increase in side effects.

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Section: Discussionsupporting

confidence: 55%

The effect of aminoglycosides on colistin-containing regimens in the treatment of carbapenem resistant gram-negative infections in pediatric intensive care units: a two-center experience

Bal¹

2019

Erciyes Med J

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“…With AKI n (%) The AKI rates reported among pediatric studies evaluating colistin efficacy and safety ranged from 0 to 22.8% (Falagas et al, 2009a;_ Işgüder et al, 2016;Kapoor et al, 2013;Karbuz et al, 2014;Karli et al, 2013;Paksu et al, 2012;Sahbudak Bal et al, 2018;Tamma et al, 2013), while the rate was found to be as high as 51% in an adult study (Miano et al, 2018). Among pediatric studies, the differing AKI rates were probably caused by many factors, such as patient characteristics, number of patients studied, AKI definition, and colistin dosing.…”

Section: Totalmentioning

confidence: 99%

“…In adults, the acute kidney injury (AKI) rate was reported as 51% in patients using colistin, while in the matched controls the AKI rate was 22% (Miano et al, 2018). In children, the nephrotoxicity rate has been reported over a range from 0 to 22.8%, based on various nephrotoxicity definitions (Falagas et al, 2009a;_ Işgüder et al, 2016;Kapoor et al, 2013;Karbuz et al, 2014;Karli et al, 2013;Paksu et al, 2012;Sahbudak Bal et al, 2018;Tamma et al, 2013). The nephrotoxicity usually occurred when colistin was given concomitantly with other, more nephrotoxic drugs, such as vancomycin or aminoglycosides (Rattanaumpawan et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

No increased acute kidney injury rate through giving an intravenous colistin loading dose in pediatric patients

Wacharachaisurapol

Kawichai

Chanakul

et al. 2021

International Journal of Infectious Diseases

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A colistin loading dose is required to achieve adequate drug exposure for the treatment of multidrug-resistant Gram-negative bacteria. However, data on acute kidney injury (AKI) rates associated with this approach in children have been unavailable. The aim of this study was to examine AKI rates in children who were prescribed a colistin loading dose. Methods: A retrospective study was conducted in patients aged 1 month to 18 years who had received intravenous colistin for !48 h. Loading dose (LD) was defined as colistin methanesulfonate at 4-5 mg of colistin base activity/kg/dose. AKI was defined according to KDIGO serum creatinine (SCr) criteria -SCr ! 1.5 times the baseline, measured 3-7 days after colistin initiation. Augmented renal clearance (ARC) was defined as an estimated glomerular filtration rate (eGFR) >150 mL/min/1.73 m 2 . The rates of AKI were compared between children receiving or not receiving an LD, and between different eGFR groups. Results: In total, 181 children were enrolled. The mean age was 4.3 years (95% confidence interval [CI], 3.6-4.9 years). Ninety-five of the subjects (52.5%) were male. There were 157 children with a baseline eGFR of ! 80 mL/min/1.73 m 2 . The overall AKI rate within the first week in this group was 20.4% (95% CI, 14.4-27.6%): LD,16.1% vs no LD, 23.2% (p = 0.29). Subgroup analysis, excluding patients with ARC, showed a lower AKI rate of 12.8% (95% CI, 6.8-21.3%): LD, 9.7% vs no LD, 14.3% (p = 0.53). Conclusions: AKI rate was not different among children who received an intravenous colistin loading dose. This approach should be implemented to ensure the necessary drug exposure required for good treatment outcomes.

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“…colistinus [ 14 ], is a potent broad-spectrum antimicrobial. This antibiotic is commonly used for the treatment of challenging Gram-negative pathogens[ 15 ], including A . baumannii .…”

Section: Introductionmentioning

confidence: 99%

Dynamic Computational Model of Symptomatic Bacteremia to Inform Bacterial Separation Treatment Requirements

et al. 2016

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The rise of multi-drug resistance has decreased the effectiveness of antibiotics, which has led to increased mortality rates associated with symptomatic bacteremia, or bacterial sepsis. To combat decreasing antibiotic effectiveness, extracorporeal bacterial separation approaches have been proposed to capture and separate bacteria from blood. However, bacteremia is dynamic and involves host-pathogen interactions across various anatomical sites. We developed a mathematical model that quantitatively describes the kinetics of pathogenesis and progression of symptomatic bacteremia under various conditions, including bacterial separation therapy, to better understand disease mechanisms and quantitatively assess the biological impact of bacterial separation therapy. Model validity was tested against experimental data from published studies. This is the first multi-compartment model of symptomatic bacteremia in mammals that includes extracorporeal bacterial separation and antibiotic treatment, separately and in combination. The addition of an extracorporeal bacterial separation circuit reduced the predicted time of total bacteria clearance from the blood of an immunocompromised rodent by 49%, compared to antibiotic treatment alone. Implementation of bacterial separation therapy resulted in predicted multi-drug resistant bacterial clearance from the blood of a human in 97% less time than antibiotic treatment alone. The model also proposes a quantitative correlation between time-dependent bacterial load among tissues and bacteremia severity, analogous to the well-known ‘area under the curve’ for characterization of drug efficacy. The engineering-based mathematical model developed may be useful for informing the design of extracorporeal bacterial separation devices. This work enables the quantitative identification of the characteristics required of an extracorporeal bacteria separation device to provide biological benefit. These devices will potentially decrease the bacterial load in blood. Additionally, the devices may achieve bacterial separation rates that allow consequent acceleration of bacterial clearance in other tissues, inhibiting the progression of symptomatic bacteremia, including multi-drug resistant variations.

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Safety and efficacy of intravenous colistin use for the treatment of nosocomial multidrug-resistant Acinetobacter baumannii infections in a pediatric intensive care unit

Abstract: Intensive care unit environmental surfaces are contaminated by multidrugresistant bacteria in biofilms: combined results of conventional culture, pyrosequencing, scanning electron microscopy, and confocal laser microscopy.

Cited by 7 publications

References 5 publications

The effect of aminoglycosides on colistin-containing regimens in the treatment of carbapenem resistant gram-negative infections in pediatric intensive care units: a two-center experience

The effect of aminoglycosides on colistin-containing regimens in the treatment of carbapenem resistant gram-negative infections in pediatric intensive care units: a two-center experience

No increased acute kidney injury rate through giving an intravenous colistin loading dose in pediatric patients

Dynamic Computational Model of Symptomatic Bacteremia to Inform Bacterial Separation Treatment Requirements

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