The use of polymyxins to treat carbapenem resistant infections in neonates and children

Thomas, Reenu; Velaphi, Sithembiso; Ellis, Sally; Walker, A Sarah; Standing, Joseph F.; Heath, Paul T; Sharland, Mike; Donà, Daniele

doi:10.1080/14656566.2018.1559817

Cited by 40 publications

(31 citation statements)

References 65 publications

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“…However, cefiderocol and similar agents are expensive with limited availability in low-income and middle-income countries (LMICs). Colistin is available in LMICs and is used for most of the susceptible CROs 12. Colistin can cause a high rate of neurotoxicity and nephrotoxicity if administered in high doses intramuscularly, although toxicities are negligible when given intravenously 13.…”

Section: Introductionmentioning

confidence: 99%

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

Gul

Salat²,

Hussain

et al. 2020

Arch Dis Child

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ObjectiveInfections with multidrug-resistant organisms (MDROs) such as Gram-negative bacteria have high morbidity and mortality with limited treatment options. Colistin, an antibiotic active against MDRO, was rarely used due to frequent adverse effects, but its use has now been recommended among adults. In this study, we determined the efficacy of colistin for the treatment of sepsis in neonates.Design/setting/patients/outcomesWe conducted a retrospective record review of all neonates admitted to the neonatal intensive care unit of Aga Khan University Hospital, Karachi, Pakistan, between June 2015 and June 2018, who had sepsis and received colistin by intravenous, inhalation and/or intrathecal routes. Predictors of colistin efficacy, for neonatal survival and microbial clearance, were assessed using multiple logistic regression.Results153 neonates received colistin; 120 had culture-proven sepsis; and 93 had MDR-GNB (84 colistin-sensitive). 111 (72.5%) neonates survived and were discharged from hospital; 82.6% had microbial clearance. Neonates with colistin-sensitive bacteria (adjusted OR (AOR)=3.2, 95% CI 2.8 to 4.0), and those in which colistin therapy started early (AOR=7.2, 95% CI 3.5 to 13.6) were more likely to survive. Neonates with increased gestational age (AOR=1.9, 95% CI 1.5 to 3.0), higher weight (AOR=5.4, 95% CI 3.3 to 11.8) and later onset of sepsis (AOR=4.3, 95% CI 2.0 to 9.0) had higher survival. Adverse events included nephrotoxicity in 5.2%; 13.7% developed seizures and 18.3% had electrolyte imbalance.ConclusionsColistin therapy was associated with survival among neonates suffering from MDR-GNB sepsis. The frequency of side effects was moderate.

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Section: Introductionmentioning

confidence: 99%

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

Gul

Salat²,

Hussain

et al. 2020

Arch Dis Child

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“…However, medical practitioners still follow a pattern of usage in human infections, where carbapenems and polymyxins are considered to be last resort antibiotics in treatment. By contrast, in the animal production industry, polymyxins are routinely used as growth promoters [5,6]. Under such contrasting usage practices, both foodborne pathogens and high human usage of antibiotics can impact human health [7].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Colistin-Resistant, Carbapenem-Hydrolyzing Proteobacteria in Hospital Water Bodies and Out-Falls of West Bengal, India

Bardhan

Chakraborty

Bhattacharjee

2020

IJERPH

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Indiscriminate use of antibiotics has resulted in a catastrophic increase in the levels of antibiotic resistance in India. Hospitals treat critical bacterial infections and thus can serve as reservoirs of multidrug resistant (MDR) bacteria. Hence, this study was conducted to gauge the prevalence patterns of MDR bacteria in hospital wastewater. Water samples collected from 11 hospitals and 4 environmental sources belonging to 5 most-densely populated districts of West Bengal, India were grown on MacConkey and Eosin Methylene Blue agar. A total of 84 (hospital-associated = 70, environmental water sources = 14) isolates were characterized. The predominant species found in water from hospital-associated areas (HAA) were Acinetobacter baumannii (22.9%), Escherichia coli (28.6 %), and Klebsiella pneumoniae (25.7%). Greater than 75% of the HAA isolates were found to be mcr-1 gene negative and colistinresistant. Meropenem non-susceptibility was also high among the HAA isolates at 58.6%, with the presence of the carbapenemase gene and blaNDM in 67.1% of the non-susceptible isolates. Among the three predominant species, significantly higher numbers of E. coli isolates were found to be non-susceptible to meropenem ((80%), p-value = 0.00432) and amikacin (AK (90%), p-value = 0.00037). This study provides evidence for the presence of high numbers of colistin-resistant and carbapenem-hydrolyzing Proteobacteriain hospital wastewater.

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“…Polymyxins. Since the advent of a growing number of MDR infections, polymyxins have been studied in pediatric populations of different ages (99,100). Nephrotoxicity is one of the main concerns (99), with a higher risk being seen among adolescents (101).…”

Section: Treatmentmentioning

confidence: 99%

“…In the case of central nervous system infections, other routes for colistin administration (e.g., intraventricular/intrathecal) may be considered (105). In critically ill patients with life-threatening infections, it is recommended that treatment be started with a loading dose in order to achieve therapeutic concentrations more quickly (100,106), although no data support this recommendation in children.…”

Section: Treatmentmentioning

confidence: 99%

Carbapenem-Resistant Gram-Negative Bacterial Infections in Children

Aguilera‐Alonso

Escosa-García

Saavedra-Lozano

et al. 2020

Antimicrob Agents Chemother

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Carbapenem-resistant organisms (CRO) are a major global public health threat. Enterobacterales hydrolyze almost all β-lactams through carbapenemase production. Infections caused by CRO are challenging to treat due to the limited number of antimicrobial options. This leads to significant morbidity and mortality. Over the last few years, several new antibiotics effective against CRO have been approved. Some of them (e.g., plazomicin or imipenem-cilastatin-relebactam) are currently approved for use only by adults; others (e.g., ceftazidime-avibactam) have recently been approved for use by children. Recommendations for antibiotic therapy of CRO infections in pediatric patients are based on evidence mainly from adult studies. The availability of pediatric pharmacokinetic and safety data is the cornerstone to broaden the use of proposed agents in adults to the pediatric population. This article provides a comprehensive review of the current knowledge regarding infections caused by CRO with a focus on children, which includes epidemiology, risk factors, outcomes, and antimicrobial therapy management, with particular attention being given to new antibiotics.

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The use of polymyxins to treat carbapenem resistant infections in neonates and children

Cited by 40 publications

References 65 publications

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

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

Prevalence of Colistin-Resistant, Carbapenem-Hydrolyzing Proteobacteria in Hospital Water Bodies and Out-Falls of West Bengal, India

Carbapenem-Resistant Gram-Negative Bacterial Infections in Children

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