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Investigation of colistin utilization in the treatment of multidrug-resistant gram-negative nosocomial bloodstream ınfections in children and literature review

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Abstract

This retrospective study aimed to assess the effectiveness and safety of colistin used in combination therapy for treating nosocomial bloodstream infections caused by multi-drug resistant gram-negative pathogens in pediatric patients. Patients aged between 1 month and 18 years consecutively hospitalized with healthcare-associated bloodstream infections necessitating the administration of intravenous colistin at Dr. Sami Ulus Training and Research Hospital between January 2015 and January 2020 were included in the study. Patient-specific detailed clinical information, prognoses, and laboratory findings on days 1, 3, and 7 of colistin treatment were obtained from medical records. The study included 45 pediatric patients receiving intravenous colistin; 26 (57.8%) were male and 19 (42.2%) were female, with a median age of 18 months. While the clinical response was observed at 82.2% and microbiological response at 91.1% with colistin treatment, two patients (4.4%) discontinued treatment due to side effects without assessing treatment response. The most common adverse effect associated with the use of colistin was nephrotoxicity, which occurred in eight patients (17.8%). Among these patients, only one had pre-existing chronic kidney failure.

   Conclusion: Colistin used in combination therapy may be effective and safe for treating nosocomial infections caused by multi-drug resistant gram-negative bacteria in pediatric patients, who often have high mortality rates and limited treatment options.

What is Known:

• Colistin is an antibacterial agent used in the treatment of infections caused by multidrug-resistant Gram-negative bacteria (MDR-GNB) and is associated with significant adverse effects such as nephrotoxicity.

• The increasing prevalence of hospital-acquired infections has led to the expanded use of colistin in clinical practice.

What is New:

• The study demonstrates a high clinical and microbiological response rate to combination therapy with colistin in the treatment of infections caused by MDR-GNB.

• The study highlights the importance of monitoring nephrotoxicity in pediatric patients receiving colistin, showing that these effects can be reversible after treatment cessation.

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Data availability

No datasets were generated or analysed during the current study.

Abbreviations

BUN:

Blood urea nitrogen

CMS:

Colistimethate sodium

CRP:

C-reactive protein

KDIGO:

Kidney Disease: Improving Global Outcomes

MDR-GNB:

Multidrug-resistant gram-negative bacteria

WBC:

Peripheral blood leukocyte count

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of General Pediatrics, Dr. Sami Ulus Maternity and Children’s Research and Training Hospital, Ankara, Turkey

    Cankat Genis

  2. Department of Pediatric Infectious Diseases, Dr. Sami Ulus Maternity and Children’s Research and Training Hospital, Ankara, Turkey

    Ayse Kaman & Gönül Tanır

  3. Department of Pediatric Emergency, Dr. Sami Ulus Maternity and Children’s Research and Training Hospital, Ankara, Turkey

    Betül Öztürk

Authors
  1. Cankat Genis
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  2. Ayse Kaman
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  3. Betül Öztürk
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  4. Gönül Tanır
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Dr. Cankat Geniş, Dr. Ayşe Kaman, Dr. Betül Öztürk, and Dr. Gönül Tanır. The first draft of the manuscript was written by Dr. Cankat Geniş and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Cankat Genis.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Dr. Sami Ulus Maternity and Children's Research and Training Hospital (2020/No:E-20/12-43).

Consent to participate

Informed consent was obtained from all individual participants included in the study. Written informed consent was obtained from the parents.

Consent to publish

The authors affirm that human research participants provided informed consent for the publication of Tables 1, 2, 3, and 4.

Competing interest

The authors declare no competing interests.

Additional information

Communicated by Tobias Tenenbaum

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Genis, C., Kaman, A., Öztürk, B. et al. Investigation of colistin utilization in the treatment of multidrug-resistant gram-negative nosocomial bloodstream ınfections in children and literature review. Eur J Pediatr (2024). https://doi.org/10.1007/s00431-024-05607-2

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  • DOI: https://doi.org/10.1007/s00431-024-05607-2

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