Rosanova Maria, Epelbaum Carolina, Noman Alejandro, Villasboas Mabel, Alvarez Veronica, Berberian Griselda, Sberna Norma, Mudryck Gabriela, Lede Roberto
Hospital Juan P. Garrahan, Argentinean Institute for Evidence Based Medicine (IAMBE), Buenos Aires, Argentina.
J Burn Care Res. 2009 Jul-Aug;30(4):612-5. doi: 10.1097/BCR.0b013e3181abffb6.
The use of sulfomethate sodium colistin for the treatment of infections caused by multiple drug resistant (MDR) Gram-negative microorganisms were studied in a burn unit to evaluate the safety of this drug. A prospective chart review of pediatric patients treated with intravenous colistin in a tertiary burn unit between January 2005 and December 2006 was performed. Forty-five courses of intravenous colistin treatment administered to 45 children were evaluated in the study period. Fourteen patients (31%) were infected by Pseudomonas aeruginosa spp and 20 patients (44.5%) by Acinetobacter spp and an association of both bacteria was found in six patients (13.5%).The mean age of the patients was 52 months (range, 2 to 168 months), and 28 patients (62%) were men. The percentage of burnt body surface was between 9 and 87% (mean, 38%). Forty patients (89%) were infected by MDR organisms. Colistin was empirically indicated in five patients (11%) with burn wound sepsis 7 days after admission to the unit despite negative cultures. Burn wound sepsis was the most frequent focus of infection in 19 patients (42%). In 14 patients (31%), burn wound infection occurred without sepsis. Intravascular catheter-related bacteremia occurred in three patients (7%) and bacteremia in one (2%). Three patients had pneumonia (7%), three osteomyelitis (7%), and two urinary tract infection (4%).The length of treatment with colistin was between 3 and 92 days (median, 21 days). Only one patient (2%) died for reasons other than infection. None of the children developed increases in serum creatinine concentrations or neurological complications during treatment with colistin. Colistin seems to be a safe drug in selected cases of infections with MDR Gram-negative microorganisms. Further studies are needed to confirm these results.
在一个烧伤病房对多粘菌素甲磺酸钠用于治疗多重耐药（MDR）革兰氏阴性微生物引起的感染进行了研究，以评估该药物的安全性。对2005年1月至2006年12月在一家三级烧伤病房接受静脉注射多粘菌素治疗的儿科患者进行了前瞻性病历回顾。在研究期间，对45名儿童接受的45个疗程的静脉注射多粘菌素治疗进行了评估。14名患者（31%）感染了铜绿假单胞菌属，20名患者（44.5%）感染了不动杆菌属，6名患者（13.5%）同时感染了这两种细菌。患者的平均年龄为52个月（范围为2至168个月），28名患者（62%）为男性。烧伤体表面积百分比在9%至87%之间（平均为38%）。40名患者（89%）感染了多重耐药菌。尽管培养结果为阴性，但仍有5名患者（11%）在入院7天后因烧伤创面脓毒症经验性使用了多粘菌素。烧伤创面脓毒症是19名患者（42%）最常见的感染部位。14名患者（31%）发生了无脓毒症的烧伤创面感染。3名患者（7%）发生了血管内导管相关菌血症，1名患者（2%）发生了菌血症。3名患者发生了肺炎（7%），3名患者发生了骨髓炎（7%），2名患者发生了尿路感染（4%）。多粘菌素的治疗时间为3至92天（中位数为21天）。只有1名患者（2%）因感染以外的原因死亡。在多粘菌素治疗期间，没有儿童出现血清肌酐浓度升高或神经并发症。在选定的多重耐药革兰氏阴性微生物感染病例中，多粘菌素似乎是一种安全的药物。需要进一步的研究来证实这些结果。
