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USE OF COLISTIN FOR THE TREATMENT OF MULTI DRUG RESISTANT ISOLATES IN NEONATES
“Use of Colistin for the treatment of multi drug resistant isolates in neonates”Ejaz Ahmed Khan,1 Shehla Choudhry,1Batool Hussain,2Amna Batool1Department of Pediatrics, Shifa International Hospital,1Islamabad, Aga Khan University Hospital,2 Karachi, Pakistan
BACKGROUND AND AIMS: Experience of using colistin for multi drug resistant organisms (MDRO) in neonates remains limited. We conducted this study to report our experience of using low-dose colistin in neonates with MDRO.
METHODS: It is a retrospective study at neonatal intensive care unit (NICU) of Shifa International Hospital (SIH), Islamabad, Pakistan. The hospital records of neonates admitted from January 2009-October 2011 were reviewed. Neonates who received colistin were analyzed for risk factors (mechanical ventilation, prolonged antibiotics, central venous catheter insertion, surgery), demographics, tolerability and side effects of colistin (fever, rash, seizures, nephrotoxicity and bronchospasm) and outcome.
RESULTS: Thirty neonates (2.8% of admissions) received colistin. Results are shown in Tables 1 and 2 (below)
Table 1. Demographics and Risk Factors for MDRO
N
%
Admissions
1053
100
Total who received Colistin
30
2.8
Males
24
80
< 37 Weeks
16
53
≥ 2 Risk Factors
13
43
Mechanical Ventilation
26
87
Prolonged Antibiotics
7
23
Central Venous Catheter
4
13
Common MDRO isolates
•Acinetobacter spp. •Pseudomonas spp.
22
7
73
23
Antibiotic Resistance
•Colistin •Cephalosporins, Aminoglycosides and Carbapenems •Piperacillin-Tazobactam
0
30
29
0
100
96.7
Table 2. Treatment and Outcome
N
%
Dose of Colistin
•Inhaled 250,000 units/day •Intravenous 25,000 units/kg/dayIndications of Colistin Administration
•Clinical Sepsis •Bacteremia •Colonization •Pneumonia
18
2
8
2
60
7
26
7
Routes of Treatment
•Inhaled + Intravenous Colistin •Inhaled Colistin Only •Intravenous Colistin only
15
9
6
50
30
20
Side effects of Colistin
0
0
Expired★
5
16.7
★No difference of mortality between routes of administration (p=0.24)
Conclusions: Low-dose colistin therapy is well tolerated in neonates for treatment of MDRO.
Key words: Colistin, Multi drug resistant organisms, Neonatal Infections, Colonization, Drug side effects
