title: The use of colistin in critically ill children in a pediatric intensive care unit.
abstract: BACKGROUND
  Colistin is active against most multidrug-resistant, aerobic Gram-negative bacteria. Because of the reported nephrotoxicity during the first years of use of colistin, there were concerns of its use in pediatrics where there was limited experience The aim of this study is to document the clinical characteristics and outcomes of use of colistin in pediatric patients at a pediatric intensive care unit in Turkey.
  
  
  METHODS
  We reviewed the medical and laboratory records of 29 critically ill children who were treated with colistin for 38 courses between January 2011 and December 2011 at the Department of Pediatric Intensive Care Unit in Ankara University Medical School, Turkey.
  
  
  RESULTS
  The median age was 17 months (range 3-217 months). Male-to-female ratio was 1:1.37. Ventilator-associated pneumonia (21 courses) was the leading diagnosis followed by catheter-related blood stream infection (6 courses), bacteremia (4 courses), ventriculoperitoneal shunt infection, peritonitis and pneumonia (1 course). The most commonly isolated microorganisms were Acinetobacter baumanni, Pseudomonas aeruginosa, Klebsiella pneumoniae, Serratia marcescens, Stenotrophomonas maltophilia, and Enterobacter cloacae. Two colistin formulations were used. Colimycin (Kocak Farma) was used in 21 colistin treatment episodes. The median dosage of colistin in this group was 5.0 mg/kg/d (2.3-5.6 mg/kg/d). Colomycin (Forest Laboratories) was used in 17 colistin treatment episodes. The median dosage of colistin in the second group was 75,000 International Unit/kg/d (50,000-80,000 International Unit/kg/d). Thirty colistin treatment episodes (79%) had a good or partial clinical response and 8 (21%) had a poor clinical response. Of the 8 colistin treatment episodes with poor clinical response, 3 were in the Colimycin group and 5 were in the Colomycin group. Ten patients died. There was no evidence of neurotoxicity in this study. Nephrotoxicity was observed in 1 patient but was not attributed to colistin because the patient had multiorgan failure at the same time.
  
  
  CONCLUSIONS
  This study in a small cohort of patients suggests that the use of colistin in severe nosocomial infections caused by multidrug-resistant Gram-negative bacteria is well-tolerated and efficacious.
authors.affiliation: From the *Department of Pediatric Infectious Diseases; †Department of Pediatric Intensive Care Unit; ‡Department of Clinical Microbiology; and §Department of Biostatistics, Ankara University School of Medicine, Dikimevi, Ankara, Turkey.
authors.forename: Adem
authors.initials: A
authors.lastname: Karbuz
authors.forename: Halil
authors.initials: H
authors.lastname: Özdemir
authors.forename: Ayhan
authors.initials: A
authors.lastname: Yaman
authors.forename: Bilge Aldemir
authors.initials: BA
authors.lastname: Kocabaş
authors.forename: Çağlar
authors.initials: Ç
authors.lastname: Odek
authors.forename: Haluk
authors.initials: H
authors.lastname: Güriz
authors.forename: Ahmet Derya
authors.initials: AD
authors.lastname: Aysev
authors.forename: Ergin
authors.initials: E
authors.lastname: Çiftçi
authors.forename: Tanil
authors.initials: T
authors.lastname: Kendirli
authors.forename: Can
authors.initials: C
authors.lastname: Ateş
authors.forename: Erdal
authors.initials: E
authors.lastname: İnce
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003091:Colistin / Q000009:adverse effects / Q000627:therapeutic use*; D016638:Critical Illness; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D003091:Colistin