title: An audit of colistin use in neonatal sepsis from a tertiary care centre of a resource-limited country.
abstract: OBJECTIVE
  Sepsis due to multidrug-resistant Gram-negative pathogens is a challenge for clinicians and microbiologists and has led to use of parenteral colistin. There is a paucity of data regarding safety and efficacy of intravenous colistin use in neonates. The objective of this retrospective analysis was to study the efficacy and safety of intravenous colistin in the treatment of neonatal sepsis.
  
  
  METHODS
  An audit of the data from neonates, admitted to a neonatal intensive care unit of a tertiary care hospital during January 2012 to December 2012, and who received intravenous colistin was carried out.
  
  
  RESULTS
  Sixty two neonates received intravenous colistin (52 preterm and 10 term) for the treatment of pneumonia, bloodstream infections and meningitis. The isolated pathogens in decreasing order of frequency were Acinetobacter baumannii, Klebsiella pneumonia and Pseudomonas aeruginosa. Of the total 62 neonates, 41 (66.12%) survived and 21 (33.87%) died. Significantly higher mortality was observed in neonates with lower body weights (P < 0.05). A significant association of mortality was found in those with sepsis due to Klebsiella species. Only one of seven with this infection survived as against 15 of the 23 who grew other organisms [P = 0.03; crude odds ratio = 11.25 (1.2, 110.5)]. None of the neonates developed neurotoxicity or nephrotoxicity.
  
  
  CONCLUSIONS
  This retrospective study in neonates with sepsis showed that intravenous colistin was safe and effective in the treatment of neonatal sepsis. Further, well-controlled, prospective clinical trials need to be done to corroborate these findings.
authors.affiliation: Department of Neonatology, Seth GS Medical College & KEM Hospital, Mumbai, India.
authors.forename: Bonny
authors.initials: B
authors.lastname: Jasani
authors.affiliation: Department of Clinical Pharmacology, Seth GS Medical College & KEM Hospital, Mumbai, India.
authors.forename: Sridharan
authors.initials: S
authors.lastname: Kannan
authors.affiliation: Department of Neonatology, Seth GS Medical College & KEM Hospital, Mumbai, India.
authors.forename: Ruchi
authors.initials: R
authors.lastname: Nanavati
authors.affiliation: Department of Clinical Pharmacology, Seth GS Medical College & KEM Hospital, Mumbai, India.
authors.forename: Nithya J
authors.initials: NJ
authors.lastname: Gogtay
authors.affiliation: Department of Clinical Pharmacology, Seth GS Medical College & KEM Hospital, Mumbai, India.
authors.forename: Urmila
authors.initials: U
authors.lastname: Thatte
mesh_terms: D040981:Acinetobacter baumannii / Q000187:drug effects / Q000472:pathogenicity; D061605:Administration, Intravenous; D003091:Colistin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000472:pathogenicity; D008297:Male; D008581:Meningitis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D000071074:Neonatal Sepsis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D011014:Pneumonia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000472:pathogenicity; D062606:Tertiary Care Centers
chemical_list: D003091:Colistin