The use of intravenous colistin among children in the United States: results from a multicenter, case series.

TitleThe use of intravenous colistin among children in the United States: results from a multicenter, case series.
Publication TypeJournal Article
Year of Publication2013
AuthorsTamma PD, Newland JG, Pannaraj PS, Metjian TA, Banerjee R, Gerber JS, Weissman SJ, Beekmann SE, Polgreen PM, Hersh AL
JournalPediatr Infect Dis J
Volume32
Issue1
Pagination17-22
Date Published2013 Jan
ISSN1532-0987
KeywordsAdministration, Intravenous, Adolescent, Analysis of Variance, Anti-Bacterial Agents, Bacterial Infections, Child, Child, Preschool, Colistin, Drug Resistance, Bacterial, Humans, Infant, Kidney Diseases, Logistic Models, Practice Patterns, Physicians', Retrospective Studies, Treatment Outcome, United States
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 β-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.

DOI10.1097/INF.0b013e3182703790
Alternate JournalPediatr. Infect. Dis. J.
PubMed ID22935871
PubMed Central IDPMC4427054
Grant ListKL2 RR025006 / RR / NCRR NIH HHS / United States
KL2RR025006 / RR / NCRR NIH HHS / United States
U50 CI000358 / CI / NCPDCID CDC HHS / United States
U50 CK000187 / CK / NCEZID CDC HHS / United States