The Use of Intravenous Colistin Among Children in the United States

Abstract

Background A rapid increase in multidrug-resistant Gram-negative infections has led to a reemergence of colistin use globally. Although it is well described among adults, colistin use and its associated toxicities in children are poorly understood. We report findings from the largest case series of pediatric colistin use to date. Methods We queried pediatric infectious diseases specialists from the Emerging Infections Network to identify members who had prescribed intravenous colistin within the past 7 years. We collected relevant demographic and clinical data. Bivariate analyses and multivariable logistic regression were performed. Results Two hundred twenty-nine pediatric infectious diseases specialists completed the survey (84% response); 22% had prescribed colistin to children. Among respondents, 92 cases of colistin use from 25 institutions were submitted. The most commonly targeted organisms were multidrug-resistant Pseudomonas (67.4%), multidrug-resistant Acinetobacter baumanii (11.9%), carbapenemase-producing Enterobacteriaceae (13.0%) and extended-spectrum β-lactamase producing Enterobacteriaceae (5.4%). Development of resistance to colistin was observed in 20.5% of patients. Additional antimicrobial therapy was administered to 84% of patients, and 22% of children experienced nephrotoxicity (not associated with dosage or interval of colistin prescribed). Renal function returned to baseline in all patients. Children aged ≥13 years had approximately 7 times the odds of developing nephrotoxicity than younger children, even after controlling for receipt of additional nephrotoxic agents (odds ratio 7.16; 95% confidence interval: 1.51–14.06; P = 0.013). Four children exhibited reversible neurotoxicity. Conclusions Most pediatric infectious diseases specialists have no experience prescribing colistin. Colistin use in children has been associated primarily with nephrotoxicity and, to a lesser extent, neurotoxicity, both of which are reversible. Emergence of resistance to colistin is concerning.

Neonatal infections due to multi-resistant strains: Epidemiology, current treatment, emerging therapeutic approaches and prevention

“…For higher-level of resistance colistin could be considered. Recent clinical reports have demonstrated a more favorable tolerability and safety profile of colistin compared with reports from several decades ago with nephrotoxity and neurotoxity varied in different studies from 3.5% to 22% and from 0% to 4% of children, respectively [50,51]. Colistin is largely experienced in the neonatal population, but it must be kept in mind that is not effective against Proteus and Serratia.…”

Correlation of β-Lactamase Production and Colistin Resistance among Enterobacteriaceae Isolates from a Global Surveillance Program

“…A recent study documented the in vivo evolution of a KPC-producing Klebsiella pneumoniae isolate to a stable colistin-resistant phenotype following low-dosage colistin use (13), and colistin heteroresistance among Enterobacteriaceae isolates following colistin therapy has also been reported (18). In addition to these resistance issues, related toxicity issues are also a concern (19). Furthermore, several focused studies have documented case reports and the possible hospital transmission of carbapenemase-producing, colistinresistant Enterobacteriaceae (7,8,11).…”

The Performance of a Long-Term Antibacterial Therapy in Children With Cystic Fibrosis During Primary Plating of Pseudomonas Aeruginosa

“…В 1980 г. появились публикации о нефрологическом побочном действии пре-парата, и частота его использования снизилась. Однако в связи с возросшей резистентностью микробов (в осо-бенности грамотрицательных бактерий) к антибиотикам пришлось пересмотреть лечебные свойства полимикси-нов в их пользу [23].…”

“…У коли-стиметата натрия есть еще одно свойство: в результате присоединения к липополисахариду подавляется актив-ность эндотоксинов, а следовательно, снижается содер-жание сывороточного эндотоксина и фактора некроза опухоли ␣ [23].…”

“…В зарубежной литературе описано эффективное применение препарата не только в виде ингаляций, но и путем внутримышечного и внутривенного введения, у детей, подростков и взрослых [23].…”