title: Intravenous Colistin Use for Multidrug-Resistant Gram-Negative Infections in Pediatric Patients.
abstract: BACKGROUND
  The emergence of infections due to multidrug-resistantGram-negative bacilli (MDR-GNB)has led to the resurrection of colistin use. The data on colistin use and drug-related adverse effects in children are scarce.
  
  
  OBJECTIVE
  In this study, we aimed to evaluate the clinical efficacy and safety of colistin use in critically ill pediatric patients.
  
  
  METHODS
  This study has a retrospective study design.
  
  
  METHODS
  Sixty-one critically ill children were identified through the department's patient files archive during the period from January 2011 to November 2014.
  
  
  RESULTS
  Twenty-nine females and thirty-two males with a mean±standard deviation (SD) age of 61±9 months (range 0-216, median 12 months) received IV colistin due to MDR-GNB infections. Bacteremia (n=23, 37.7%) was the leading diagnosis, followed by pneumonia (n=19, 31%), clinical sepsis (n=7, 11.4%), wound infection (n=6, 9.8%), urinary tract infection (n=5, 8.1%) and meningitis (n=1, 1.6%). All of the isolates were resistant to carbapenems; however, all were susceptible to colistin. The isolated microorganisms in decreasing order of frequency were:Acinetobacter baumanni(n=27, 44.2%), Pseudomonas aeruginosa (n=17, 27.8%),Klebsiella pneumoniae(n=6, 9.8%),K. pneumoniaeandStenotrophomonas maltophilia(n=1, 1.6%),K. pneumoniaeandA. baumanni(n=1, 1.6%), K. oxytoca (n=1, 1.6%) and Enterobacter cloacae (n=1, 1.6%). In seven patients, no microorganisms were detected; however, five of these patients were colonized by carbapenem-resistant K. pneumoniae. The mean duration of colistin therapy was 12 days (range 3-45). Colistin was administered concomitantly with one of the following antibiotics: carbapenem (n=50, %82), ampicillin-sulbactam (n=5, 8%), quinolones (n=5, 8%), rifampicin (n=1, 1.6%). Carbapenem was the most frequently used antibiotic. Nephrotoxicity was observed in only 1 patient, and we did not observe neurotoxicity in this study. All the patients received intravenous colistin (colisthimethate) at a dosage of 5 mg/kg daily by dividing it in three equal doses. Seven (11.4%) patients died during the study period.
  
  
  CONCLUSIONS
  Colistin appears to be a safe and efficacious drug for treating MDR-GNB infections in children.
authors.affiliation: Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey.
authors.forename: Ayşe
authors.initials: A
authors.lastname: Karaaslan
authors.affiliation: Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey.
authors.forename: Eren
authors.initials: E
authors.lastname: Çağan
authors.affiliation: Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey.
authors.forename: Eda Kepenekli
authors.initials: EK
authors.lastname: Kadayifci
authors.affiliation: Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Atıcı
authors.affiliation: Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey.
authors.forename: Gülşen
authors.initials: G
authors.lastname: Akkoç
authors.affiliation: Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey.
authors.forename: Nurhayat
authors.initials: N
authors.lastname: Yakut
authors.affiliation: Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey.
authors.forename: Sevliya Öcal
authors.initials: SÖ
authors.lastname: Demir
authors.affiliation: Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Soysal
authors.affiliation: Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Bakır
keywords: Colistin; children; multidrug-resistant gram-negative infections