Evaluation of colistin use in hospitalized children in pediatric clinics

ABSTRACT Evaluation of Colistin use in Hospitalized Children in Pediatric Clinics Colistin, which its use was restricted due to nephrotoxicity and neurotoxicity earlier, has begun to be reused due to increased infection rates caused by Gram negative bacteria with multiple antibiotic resistance, particularly with Acinetobacter baumanni, Klebsiella pneumonia, and Pseudomonas aeruginosa in recent years. In this study, we aimed to investigate the indications, dose, clinical response, and possible side effects of colistin, of which pharmacodynamics and pharmacokinetics have not been fully understood yet, and to evaluate its efficacy in clinical practice. This study was conducted at Dicle University, Faculty of Medicine, Department of Pediatrics between January 2013 and December 2015. A total of 49 patients who stayed longer than 48 hours in the Pediatric Intensive Care Units (PICUs) and clinics with an age range of 1 month to 18 years, irrespective of sex, and were treated with colistin were retrospectively analyzed. In addition, four patients were prospectively analyzed. A total of 63 infections were detected including repetitive infections in 53 patients who were being treated with colistin. Age and sex of the patients, diagnosis during hospitalization, clinic of hospitalization, invasive interventions including mechanical ventilation, central venous catheterization, urinary catheterization and nasogastric tube replacement, intrathecal intervention, tracheostomy, and thoracic tube replacement, comorbidities, total total parenteral nutrition, antibiotic regimens and treatment duration, presence of neutropenia, the use of immunosuppressive and H2 receptor blocking agents, and laboratory test results before treatment, on Day 5 of treatment, and after treatment were recorded. Of all patients, 33 (52.4%) were males and 30 (%47.6) were females. The mean age was 42.8±50.2 (range: 3 to 183) months, while the mean body weight was 13.8±11.7 (range: 2 to 60) kg, and the mean duration of hospitalization was 17.1±208 (range: 12 to 750) days. Of the patients, 48 (76.2%) were followed in the PICU, while 15 (23.8%) were hospitalized in the other wards. In the evaluation of microorganism growth in the cultures, Acinetobacter baumanii reproduction in 32 (50.8%) patients, Pseudomonas aeruginosa in 10 (15.9%) patients, and Klebsiella pneumoniae in one (1.6%) patient were identified. There was no reproduction in 20 (31.7%) patients. Empiric colistin was initiated in 43 patients based on culture test results and in 20 patients due to sepsis. The most common risk factors for patients receiving colistin treatment were tracheostomy, nasogastric tube replacement, hospitalization duration, and mechanical ventilation. A total of 62 patients received combined treatment, and most frequently meropenem and sulperazone were used. The mean duration of colistin was 19.7±11.1 days. Hemoglobin level was significantly lower on Day 5 of treatment, compared to the remaining days (p=0.006). Calcium level was lower before treatment, compared to the remaining days (p=0.001). There was no statistically significant difference in the other biochemical and complete blood count parameters (p>0.017). Endotracheal intubation, mechanical ventilation, nasogastric tube replacement, transfusion, previous surgery, and unconsciousness were found to statistically significantly increase mortality (p<0.05). In conclusion, colistin should be used in infections resulting from Gram negative bacteria, if there is resistance to other antibiotics. The side effects of colistin are acceptable, considering the severity of the diseases and mortality. During follow-up of patients on colistin treatment, we recommend testing hemoglobin and calcium levels, in particular. Key Words: Child, colistin, clinical response, side effectst.