Investigation of colistin utilization in the treatment of multidrug-resistant gram-negative nosocomial bloodstream ınfections in children and literature review

• Published in: European journal of pediatrics Vol. 183; no. 8; pp. 3407 - 3415
• Main Authors: Genis, Cankat, Kaman, Ayse, Öztürk, Betül, Tanır, Gönül
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2024; Springer Nature B.V
• Subjects: Adolescent; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Bacteremia - drug therapy; Bacteremia - microbiology; Child; Child, Preschool; Colistin; Colistin - administration & dosage; Colistin - adverse effects; Colistin - therapeutic use; Combination therapy; Cross Infection - drug therapy; Drug resistance; Drug Resistance, Multiple, Bacterial; Female; Gram-negative bacteria; Gram-Negative Bacteria - drug effects; Gram-Negative Bacteria - isolation & purification; Gram-Negative Bacterial Infections - drug therapy; Hematological diseases; Hospitals; Humans; Infant; Intravenous administration; Literature reviews; Male; Medical records; Medicine; Medicine & Public Health; Multidrug resistance; Nosocomial infection; Nosocomial infections; Patients; Pediatrics; Renal failure; Retrospective Studies; Side effects; Treatment Outcome; Children; Colistin; Microbiological response; Clinical response; Side effect
• ISSN: 1432-1076; 0340-6199; 1432-1076
• DOI: 10.1007/s00431-024-05607-2

This retrospective study aimed to assess the effectiveness and safety of colistin used in combination therapy for treating nosocomial bloodstream infections caused by multi-drug resistant gram-negative pathogens in pediatric patients. Patients aged between 1 month and 18 years consecutively hospitalized with healthcare-associated bloodstream infections necessitating the administration of intravenous colistin at Dr. Sami Ulus Training and Research Hospital between January 2015 and January 2020 were included in the study. Patient-specific detailed clinical information, prognoses, and laboratory findings on days 1, 3, and 7 of colistin treatment were obtained from medical records. The study included 45 pediatric patients receiving intravenous colistin; 26 (57.8%) were male and 19 (42.2%) were female, with a median age of 18 months. While the clinical response was observed at 82.2% and microbiological response at 91.1% with colistin treatment, two patients (4.4%) discontinued treatment due to side effects without assessing treatment response. The most common adverse effect associated with the use of colistin was nephrotoxicity, which occurred in eight patients (17.8%). Among these patients, only one had pre-existing chronic kidney failure.     Conclusion : Colistin used in combination therapy may be effective and safe for treating nosocomial infections caused by multi-drug resistant gram-negative bacteria in pediatric patients, who often have high mortality rates and limited treatment options. What is Known: • Colistin is an antibacterial agent used in the treatment of infections caused by multidrug-resistant Gram-negative bacteria (MDR-GNB) and is associated with significant adverse effects such as nephrotoxicity. • The increasing prevalence of hospital-acquired infections has led to the expanded use of colistin in clinical practice. What is New: • The study demonstrates a high clinical and microbiological response rate to combination therapy with colistin in the treatment of infections caused by MDR-GNB. • The study highlights the importance of monitoring nephrotoxicity in pediatric patients receiving colistin, showing that these effects can be reversible after treatment cessation.