Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. ptamma1@ jhmi.edu
Pediatr Infect Dis J. 2013 Jan;32(1):17-22. doi: 10.1097/INF.0b013e3182703790.
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.
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.
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.
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.
多药耐药革兰氏阴性感染的迅速增加导致全球重新使用粘菌素。虽然成人中已有很好的描述，但儿童中粘菌素的使用及其相关毒性仍知之甚少。我们报告了迄今为止最大的儿科粘菌素使用病例系列研究结果。
我们向新兴传染病网络的儿科传染病专家查询，以确定在过去 7 年内开过静脉用粘菌素的成员。我们收集了相关的人口统计学和临床数据。进行了双变量分析和多变量逻辑回归。
229 名儿科传染病专家完成了调查（84%的回应率）；22%的专家曾给儿童开粘菌素。在回答者中，从 25 个机构提交了 92 例粘菌素使用病例。最常见的目标病原体是多药耐药铜绿假单胞菌（67.4%）、多药耐药鲍曼不动杆菌（11.9%）、产碳青霉烯酶肠杆菌科（13.0%）和产超广谱β-内酰胺酶肠杆菌科（5.4%）。20.5%的患者对粘菌素产生耐药性。84%的患者接受了额外的抗菌治疗，22%的儿童发生了肾毒性（与粘菌素的剂量或间隔无关）。所有患者的肾功能均恢复到基线水平。年龄≥13 岁的儿童发生肾毒性的几率是年龄较小儿童的 7 倍，即使在控制了接受其他肾毒性药物的情况下（比值比 7.16；95%置信区间：1.51-14.06；P = 0.013）。4 名儿童出现了可逆转的神经毒性。
大多数儿科传染病专家没有开粘菌素的经验。儿童粘菌素的使用主要与肾毒性相关，其次是神经毒性，两者均是可逆转的。粘菌素耐药的出现令人担忧。
