Use of Colistin in a Pediatric Burn Unit in Argentina

Abstract

The use of sulfomethate sodium colistin for the treatment of infections caused by multiple drug resistant (MDR) Gram-negative microorganisms were studied in a burn unit to evaluate the safety of this drug. A prospective chart review of pediatric patients treated with intravenous colistin in a tertiary burn unit between January 2005 and December 2006 was performed. Forty-five courses of intravenous colistin treatment administered to 45 children were evaluated in the study period. Fourteen patients (31%) were infected by Pseudomonas aeruginosa spp and 20 patients (44.5%) by Acinetobacter spp and an association of both bacteria was found in six patients (13.5%).The mean age of the patients was 52 months (range, 2 to 168 months), and 28 patients (62%) were men. The percentage of burnt body surface was between 9 and 87% (mean, 38%). Forty patients (89%) were infected by MDR organisms. Colistin was empirically indicated in five patients (11%) with burn wound sepsis 7 days after admission to the unit despite negative cultures. Burn wound sepsis was the most frequent focus of infection in 19 patients (42%). In 14 patients (31%), burn wound infection occurred without sepsis. Intravascular catheter-related bacteremia occurred in three patients (7%) and bacteremia in one (2%). Three patients had pneumonia (7%), three osteomyelitis (7%), and two urinary tract infection (4%).The length of treatment with colistin was between 3 and 92 days (median, 21 days). Only one patient (2%) died for reasons other than infection. None of the children developed increases in serum creatinine concentrations or neurological complications during treatment with colistin. Colistin seems to be a safe drug in selected cases of infections with MDR Gram-negative microorganisms. Further studies are needed to confirm these results.

Colistin administration to pediatric and neonatal patients

“…A recent systematic review of literature revealed that most of the studies of colistin use that included only children have been published until late 1970s, and within these studies, there were many differences regarding administration route (i.e., intramuscularly) and dosage of colistin [9]. Reports on intravenous use of colistin in children without cystic fibrosis published after 2000 include very few cases [3,8,9,14,17,21,28,37,41]. In our study, one third of colistin courses included children aged less than 1 year.…”

“…In our study, one third of colistin courses included children aged less than 1 year. Although there are three recent case series of intravenous colistin therapy in children, two of them studied pediatric burn patients only (older than 2 months of age) [8,14,37], a patient population that tends to have significantly altered pharmacokinetic profile compared to other patients [42]. The third recent case series included seven critically ill children older than 1 year [8].…”

“…Among seven critically ill patients reported by Falagas et al, two of them had bloodstream infection and four had lower respiratory tract infections [8]. In burn patients, bloodstream and burn wound infections were the predominant type of infection [14,37].…”

“…Most of the studies that have evaluated colistin for treating infections caused by MDR Gram-negative bacteria in children included mainly patients with cystic fibrosis [9,20]. A very small number of children without cystic fibrosis have been included in published case series or case reports on safety and efficacy of intravenous colistin [8,9,14,31,37,41]. However, most of these patients had suffered from burn injuries [14,37].…”

Infecciones en los niños quemados: análisis epidemiológico y de los factores de riesgo

“…Sin embargo, no documentamos tales efectos en nuestros pacientes. 24,25 El uso de antimicrobianos locales está muy difundido, pero su eficacia es un punto de debate 26 y aparece como un factor de riesgo no independiente de infección de esta serie.…”