Safety and Efficacy of Intravenous Colistin in Neonates With Culture Proven Sepsis

Abstract

Background:Although it is well described among adults, intravenous colistin use and its associated toxicities in newborns are poorly understood.Objectives:We present our experience of efficacy and safety of intravenous colistin in the treatment of sepsis in term and preterm neonates.Patients and Methods:The records of neonates who received colistin between January 2013 and February 2014 were retrospectively reviewed. All neonates with culture proven nosocomial infections due to multidrug resistant organisms and treated continuously with colistin for more than 72 hours were included in the study.Results:Patients were evaluated for clinical and microbiological response to the drug and its and side effects. Twelve newborn infants with mean 31.8 ± 3.5 weeks gestational age and median 1482 (810 - 3200) gram birth weight were included. 11/12 (91.7%) patients showed microbiological clearance with intravenous colistin. One patient who had recurrent cerebrospinal fluid positive culture was treated with intraventricular colistin. The major side effects observed was hyponatremia and hypokalemia in 2 (16.6%) patients, all infants required magnesium supplementation.Conclusions:Intravenous colistin administration appears to be safe and efficacious for multidrug-resistant gram-negative infections in neonates, including preterm infants. However, we believe that large prospective controlled studies are needed to confirm its efficacy and safety in neonates.

Colistin use in critically ill neonates: A case–control study

“…8 Thus far, small numbers of studies on neonates have not reported any evident neurotoxicity related to colistin use. 5,8,10,12,13 Although there were various coexisting clinical conditions, which may be similar to neurotoxic findings, no adverse neurological events attributable to colistin were noted in the present study. Prospective studies are needed to explore the effect of colistin on the neonatal brain.…”

“…15 Leukopenia (leukocyte count <5000/mm 3 ), leukocytosis (leukocyte count >22,000/ mm 3 ), and a CRP level of >12 mg/L were considered indicators of sepsis. 12 A positive blood culture was required as a standard to verify cases with proven sepsis. Metabolic acidosis was considered when pH was <7.2 and the plasma bicarbonate value was <15 mEq/L in a capillary blood sample.…”

Efficacy of colistin in multidrug-resistant neonatal sepsis: experience from a tertiary care center in Karachi, Pakistan

“…Despite the reintroduction of colistin and its wide use among adults for MDR-GNB infections, there is very little evidence of colistin use in neonates. Few studies have reported intravenous use of colistin 27 30 31. This is one of the few studies with a reasonable sample size to determine the effectiveness and adverse effects of colistin in the critically ill neonatal population.…”

“…Alan et al reported 4/21 deaths in neonates treated with colistin; however, their study was limited in size and deaths within 72 hours of birth were not included 18. Serafettin Tekgunduz et al reported a 50% mortality among neonates with culture-proven sepsis treated with colistin 31…”

El desafio en la dosificación de colistin: actualización de las recomendaciones disponibles

“…Colistín fue bien tolerado en esta pequeña muestra, sin evidencias de neuro o nefrotoxicidad atribuibles. natremia e hipokalemia en dos casos (16,6%) pero el total de los pacientes requirieron suplementación de magnesio durante su uso 71 . Por otra parte, Alan y cols., comunicaron los mismos hallazgos y necesidad de suplementación de potasio en 52% de los casos 72 .…”