Old agent, new experience: colistin use in the paediatric Intensive Care Unit--a multicentre study.
Nosocomial infections caused by multidrug-resistant (MDR) microorganisms are a common problem around the world, especially in Intensive Care Units. The aim of this study was to investigate the efficacy and safety of colistin therapy in paediatric patients with severe nosocomial infections caused by MDR Gram-negative bacteria. There were 87 episodes in 79 paediatric Intensive Care Unit patients in five different hospitals; each patient was treated intravenously with colistin and evaluated. Of the 79 patients, 54.4% were male and the median age was 30 months. The most commonly isolated microorganism was Acinetobacter baumannii, the most common isolation site was tracheal aspirate fluid and the most common type of infection was ventilator-associated pneumonia. The mean colistin dose in patients without renal failure was 5.4 ± 0.6 mg/kg/day, the mean therapy duration was 17.2 ± 8.4 days and the favourable outcome rate was 83.9%. Serious side effects were seen in four patient episodes (4.6%) during therapy; two patients suffered renal failure and the others had convulsive seizures. Other patients tolerated the drug well. The infection-related mortality rate was 11.5% and the probability of death within the first 9 days of treatment was 10 times higher than after the first 9 days. In conclusion, this study suggests that colistin is effective in the treatment of severe nosocomial infections caused by MDR Gram-negative bacteria and is generally well tolerated by patients, even after relatively long-term use.
Ondokuz Mayis University, Faculty of Medicine, Pediatric Intensive Care Unit, Samsun, Turkey. sukrupaksu@yahoo.com
Muhammet Sukru
MS
Paksu
Sule
S
Paksu
Adil
A
Karadag
Gülnar
G
Sensoy
Nazik
N
Asilioglu
Dincer
D
Yildizdas
Basak Nur
BN
Akyildiz
Tanil
T
Kendirli
Demet
D
Demirkol
Muhammet
M
Akgun
Emine
E
Alp
Ergin
E
Ciftci
Akif Koray
AK
Guney
Naci
N
Murat
D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000302:isolation & purification / Q000472:pathogenicity; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003091:Colistin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D004334:Drug Administration Schedule; D004341:Drug Evaluation / Q000379:methods; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification / Q000472:pathogenicity; D051437:Renal Insufficiency / Q000139:chemically induced; D012189:Retrospective Studies; D012640:Seizures / Q000139:chemically induced; D013997:Time Factors; D016896:Treatment Outcome
D003091:Colistin