Journal article
The Use of Intravenous Colistin Among Children in the United States: Results From a Multicenter, Case Series
The Pediatric infectious disease journal, Vol.32(1), pp.17-22
01/01/2013
DOI: 10.1097/INF.0b013e3182703790
PMCID: PMC4427054
PMID: 22935871
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 beta-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.
Details
- Title: Subtitle
- The Use of Intravenous Colistin Among Children in the United States: Results From a Multicenter, Case Series
- Creators
- Pranita D. Tamma - Johns Hopkins UniversityJason G. Newland - Children's Mercy HospitalPia S. Pannaraj - University of Southern CaliforniaTalene A. Metjian - University of PennsylvaniaRitu Banerjee - Mayo Clinic in FloridaJeffrey S. Gerber - University of PennsylvaniaScott J. Weissman - Seattle Children's HospitalSusan E. Beekmann - University of IowaPhilip M. Polgreen - University of IowaAdam L. Hersh - University of Utah
- Resource Type
- Journal article
- Publication Details
- The Pediatric infectious disease journal, Vol.32(1), pp.17-22
- DOI
- 10.1097/INF.0b013e3182703790
- PMID
- 22935871
- PMCID
- PMC4427054
- NLM abbreviation
- Pediatr Infect Dis J
- ISSN
- 0891-3668
- eISSN
- 1532-0987
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 6
- Grant note
- KL2RR025006 / NATIONAL CENTER FOR RESEARCH RESOURCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Research Resources (NCRR) KL2RR025006 / National Institutes of Health grant; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA U50CI000358 / NATIONAL CENTER FOR INFECTIOUS DISEASES (NCID); United States Department of Health & Human Services; Centers for Disease Control & Prevention - USA
- Language
- English
- Date published
- 01/01/2013
- Academic Unit
- Infectious Diseases; Epidemiology; Injury Prevention Research Center; Internal Medicine
- Record Identifier
- 9984359873502771
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