Assesment of colistin related side effects in premature neonates

Abstract

Background. Colistin is an antibiotic in the polymyxin group and is especially important in the elimination of multi-drug resistant gram negative bacteria. To date, there are many studies investigating colistin related side effects, especially nephrotoxicity. However, there are few studies involving premature neonates, and this study aimed to investigate the side effects of colistin in this particular patient group. Methods. Between January 2016 and May 2019, the medical records of premature neonates treated with colistin were retrospectively reviewed. The diagnosis of acute kidney injury (AKI) was performed according to the modified neonatal KDIGO criteria. Serum electrolyte levels were recorded at the initiation of colistin treatment and 4-7 days after. Results. A total of 47 premature neonates; with a median gestational age of 27 weeks and median weight of 970 g at birth were included in the study. The median postnatal day of colistin initiation was 24 days and mean duration of colistin therapy was 15.95 ± 3.70 days. Colistin was combined with aminoglycosides in 44.6% of the patients. Acute kidney injury was documented in 17.0% of premature neonates. (n = 6 for stage 1, n = 2 for stage 2, none of the patients had stage 3). In univariate analysis, gestational age and concomitant aminoglycoside use were associated with AKI development (OR, 0.446; 95% CI 0.238-0.832; p = 0.011 and OR, 1.324; 95% CI 1.023-7.584; p = 0.024). Mean magnesium level significantly decreased after colistin treatment (1.70 ± 0.84 vs. 1.57 ± 0.29, p = 0.017) and the frequency of hypomagnesemia increased after colistin use (78.7% vs. 91.5%, p = 0.031). Frequency of elevated AST increased from 23.4% to 44.7% following colistin use (p = 0.031). Conclusions. Colistin-related side effects observed in premature neonates are not as common as in pediatric patients. Electrolyte imbalance is observed more frequently in this age group following colistin use. We suggest strict serum electrolyte level monitoring, especially magnesium, in premature neonates that are receiving colistin.

Short and long term side effect of colistin treatment in preterm infants

“…2 Similar to the results of Kaya Aksoy G and colleagues as well as Alan S and colleagues magnesium levels of the cases in our study decreased significantly after the use of colistin. 1,3 Prolonged intolerance of the gastrointestinal system was a side effect unprecedented in other studies but was observed in 9.1% of cases in our study, which diminished alongside the discontinuation of colistin. 10 patients developed cholestasis, and although the clinical signs and symptoms subsided, total resolve occurred only after discontinuation.…”

“…We read with interest the recently published article by Kaya Aksoy G et al 1 in which the side effects associated with colistin use in premature infants were evaluated.…”

Ten-year Single Center Experience With Colistin Therapy in NICU

“…Recent studies have reported an association between colistin-related nephrotoxicity and concurrent aminoglycoside use. 24,25 Aminoglycosides are among the most frequently used antibiotics in the NICU. While concurrent aminoglycosides were identified as an independent predictor of colistin-associated AKI, in some cases, the combination therapy of aminoglycosides and colistin is unavoidable.…”

Molecular mechanisms of tigecycline-resistance among Enterobacterales

“…Colistin seems to be a poor choice for patients due to severe side effects including nephrotoxicity, neurotoxicity (paresthesia, partial deafness, confusion, hallucinations, seizures, ataxia), and electrolyte imbalance. Significant side effects associated with colistin force physicians to treat infection caused by MDR pathogens using tigecycline ( Ordooei Javan et al., 2015 ; Aksoy et al., 2020 ). Adverse drug reactions of tigecycline are mild, including gastrointestinal problems (diarrhoea, nausea, vomiting), pancreatitis, fever, accompanied coinfections, thrombocytopenia, local reaction, and changes in hepatic functions (increased concentration of alanine transaminase and aspartate transaminase) ( Greer, 2006 ; Tasina et al., 2011 ).…”