Intravenous Colistin Use for Multidrug-Resistant Gram-Negative Infections in Pediatric Patients

Karaaslan, Ayşe; Çağan, Eren; Kadayıfçı, Eda Kepenekli; Atıcı, Serkan; Akkoç, Gülşen; Yakut, Nurhayat; Demir, Sevliya Öcal; Soysal, Ahmet; Bakır, Mustafa

doi:10.5152/balkanmedj.2016.16210

Cited by 22 publications

(11 citation statements)

References 25 publications

(33 reference statements)

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“…20 In this study, carbapenems were the most commonly coadministered antibiotics with colistin in 25 patients (16 adults and nine paediatrics). 6 This finding is similar to a retrospective paediatric colistin usage study by Karaaslan et al 21 from 2011 to 2014 where it was found that colistin was usually co-administered with one other antibiotic. It was noted in the present study that co-trimoxazole was also frequently co-administered in adult (63%) and paediatric (93.8%) patients.…”

Section: Discussionsupporting

confidence: 85%

A retrospective review of colistin utilisation at a tertiary care academic hospital in South Africa

Majavie

Johnston

Messina³

2021

Southern African Journal of Infectious Diseases

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Background: The use of the antibiotic colistin was increasing as a treatment option for multidrug-resistant (MDR) infections. Standardisation of colistin dosing and more appropriate record-keeping practices were required to fully assess the optimal usage of colistin. The aim of this study was to determine how and why colistin was used in the treatment of MDR infections in a tertiary care public hospital in South Africa (SA). Methods: This cross-sectional retrospective record review described adult and paediatric patients who received colistin intravenously from 01 May 2016 to 31 April 2017. Information from patient records were captured on a data collection tool and analysed using descriptive statistics. Ethical approval was obtained from the Human Research Ethics Committee of the University of the Witwatersrand.Results: A total of 43 patient records were reviewed. Acinetobacter baumannii was the most common organism isolated (85.2% adults and 62.5% paediatrics). Colistin was mostly prescribed for sepsis (18 adults and 15 paediatrics). Most adults (66.7%) received loading doses as recommended; however, there was a great variation in maintenance doses. Paediatric patients reviewed also showed varying dosing according to weight. The mean duration of colistin therapy was 10 days. Carbapenems were most commonly co-administered with colistin (58%). Conclusion:The findings suggested that although colistin usage was restricted in the hospital, it was not adequately monitored or controlled. Doses prescribed were made at the discretion of prescribing doctors and differed to currently accepted guidelines. Improved record-keeping practices related to the monitoring of colistin use were required.

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Section: Discussionsupporting

confidence: 85%

A retrospective review of colistin utilisation at a tertiary care academic hospital in South Africa

Majavie

Johnston

Messina³

2021

Southern African Journal of Infectious Diseases

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“…Unfortunately, the irrational use of antibiotics increases the risk of development of antimicrobial resistance (AMR), increasing morbidity, mortality and costs, with costs including additional visits to emergency departments, extra prescriptions for adjuvant therapies as well as prolonged hospital stay, leading to worldwide calls to address this [5][6][7][8][9][10][11][12][13]. For example, colistin has re-emerged as a valued antibiotic despite its side-effects because of the emergence of carbapenem-resistant gram-negative bacteria [14,15]. This has resulted in a number of countries, including South Africa, to develop programmes to limit its use to preserve its effectiveness [16], with colistin also now included in the WHO reserve list of antibiotics [17].…”

Section: Introductionmentioning

confidence: 99%

A multicenter point prevalence survey of antibiotic use in Punjab, Pakistan: findings and implications

Saleem

Hassali

Versporten

et al. 2019

Expert Review of Anti-infective Therapy

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Objective:In line with the recent global action plan for antimicrobial resistance, the first time such a comprehensive survey has been undertaken in Pakistan, sixth most populous country. Method:This point prevalence survey (PPS) was conducted in 13 hospitals among 7 different cities of Pakistan. The survey included all inpatients receiving an antibiotic on the day of PPS. A web-based application was used for data entry, validation, and reporting as designed by the University of Antwerp. Results:Out of 1954 patients, 1516 (77.6%) were treated with antibiotics. Top three most reported indications for antibiotic use were prophylaxis for obstetrics or gynaecological indications (16.5%) and gastrointestinal indications (12.6%) and lower respiratory tract infections (12.0%). Top three most commonly prescribed antibiotics were ceftriaxone (35.0%), metronidazole (16.0%) and ciprofloxacin (6.0%). Out of total indications, 34.2% of antibiotics were prescribed for community-acquired infections (CAI), 5.9% for healthcare-associated infections (HAI), and 57.4% for either surgical or medical prophylaxis. Of total surgical prophylaxis, 97.4% of antibiotics were given for more than one day. Conclusion:Study concluded that unnecessary prophylactic antibiotic use is extremely high and broad-spectrum prescribing is common. There is a considerable need to work on a national action plan of Pakistan on antibiotic resistance.

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“…Currently, carbapenems, polymyxins (colistin) and tigecycline are used as reserved agents for MDR infections 9,10 . However, the continual use of carbapenems and polymyxins to treat bacterial infections resistant to penicillins, cephalosporins, and carbapenems are increasing the rate of resistance to these last-resort antibiotics 2,4,9,11 . The emergence of carbapenem-and/or polymyxin-resistant MDR infections is thus limiting therapeutic options and increasing hospital stay, healthcare costs, morbidity, and mortality [12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

Molecular Epidemiology, Risk Factors and Clinical Outcomes of Carbapenem- and Polymyxin-Resistant Gram-negative Bacterial Infections in Pregnant Women and Infants: A Systematic Review

Sekyere

Reta

2020

Preprint

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BackgroundCarbapenems and polymyxins are last-resort antibiotics used to treat multidrug-resistant bacterial infections. However, resistance is increasing, even in vulnerable groups such as pregnant women and infants, for whom therapeutic options are limited.MethodUsing a diversity of databases, the literature was searched for studies investigating carbapenem and polymyxin resistance in pregnant women and infants (< 5 years).ResultA final set of 73 manuscripts were used. In almost all countries, carbapenem/polymyxin-resistant Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii infect and/or colonizes neonates and pregnant women, causing periodic outbreaks with very high infant mortalities. Plasmid-borne blaNDM, blaKPC, blaOXA-48, blaIMP,blaVIM and blaGES-5 and ompK35/36 downregulation in clonal strains accelerate the horizontal and vertical transmission of carbapenem resistance in these pathogens. High prevalence of carbapenem/polymyxin resistance and carbapenemases were present in India, China, Pakistan, Thailand, Taiwan, Turkey, Egypt, Italy, USA, South Africa, Algeria, Ghana, and Madagascar. Factors such as antibiotic therapy, prolonged hospitalization, invasive procedures, mother/infant colonization, mechanical ventilation, low-birth weight and preterm state placed infants at high risk of carbapenem/polymyxin-resistant infections. Infant mortalities ranged from 0.2% to 36.8% in different countries.ConclusionUse of polymyxins to treat carbapenem-resistant infections is selecting for resistance to both agents, restricting therapeutic options for infected infants and pregnant women. However, appropriate infection control and antibiotic therapy can contain outbreaks and clear these infections. Antibiotic stewardship, periodic rectal and vaginal screening, and strict infection control practices in neonatal ICUs are necessary to forestall future outbreaks and deaths.HighlightsCarbapenems & polymyxins are last-resort antibiotics used for multidrug-resistant infectionsResistance to these two agents are reported in infants & pregnant womenK. pneumoniae, E. coli, and A. baumannii are the most common pathogensCarbapenem & polymyxin resistance cause outbreaks with high infant mortalitiesAppropriate treatment & infection control can outbreaks & save lives

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Intravenous Colistin Use for Multidrug-Resistant Gram-Negative Infections in Pediatric Patients

Cited by 22 publications

References 25 publications

A retrospective review of colistin utilisation at a tertiary care academic hospital in South Africa

A retrospective review of colistin utilisation at a tertiary care academic hospital in South Africa

A multicenter point prevalence survey of antibiotic use in Punjab, Pakistan: findings and implications

Molecular Epidemiology, Risk Factors and Clinical Outcomes of Carbapenem- and Polymyxin-Resistant Gram-negative Bacterial Infections in Pregnant Women and Infants: A Systematic Review

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