Infectious Diseases Working Group, Society of Junior Doctors, Athens, Greece.
Division of Infectious Diseases, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
J Antimicrob Chemother. 2019 Sep 1;74(9):2497-2506. doi: 10.1093/jac/dkz165.
Data are limited regarding the clinical effectiveness and safety of intravenous colistin for treatment of infections due to MDR Gram-negative bacilli (GNB) in paediatric ICUs (PICUs).
Systematic review of intravenous colistin use in critically ill paediatric patients with MDR-GNB infection in PubMed, Scopus and EMBASE (up to 31 January 2018).
Out of 1181 citations, 7 studies were included on the use of intravenous colistin for 405 patients in PICUs. The majority of patients were diagnosed with lower respiratory tract infections, Acinetobacter baumannii being the predominant pathogen. Colistin dosages ranged between 2.6 and 18 mg/kg/day, with only one case reporting a loading dose. Emergence of colistin resistance during treatment was reported in two cases. Nephrotoxicity and neurotoxicity were reported in 6.1% and 0.5%, respectively, but concomitant medications and severe underlying illness limited our ability to definitively associate use of colistin with nephrotoxicity. Crude mortality was 29.5% (95% CI = 21.7%-38.1%), whereas infection-related mortality was 16.6% (95% CI = 12.2%-21.5%).
While the reported incidence of adverse events related to colistin was low, reported mortality rates for infections due to MDR-GNB in PICUs were notable. In addition to severity of disease and comorbidities, inadequate daily dosage and the absence of a loading dose may have contributed to mortality. As the use of colistin for treatment of MDR-GNB infections increases, it is imperative to understand whether optimal dosing of colistin in paediatric patients differs across different age groups. Thus, future studies to establish the pharmacokinetic properties of colistin in different paediatric settings are warranted.
关于儿童重症监护病房（PICU）内多重耐药革兰氏阴性菌（GNB）感染患者使用静脉注射黏菌素的临床疗效和安全性数据有限。
在 PubMed、Scopus 和 EMBASE 中系统检索关于儿童重症监护病房内患有多重耐药 GNB 感染的危重症患儿使用静脉注射黏菌素的相关研究，检索时间截至 2018 年 1 月 31 日。
在 1181 条引文中，纳入了 7 项关于在 PICU 中对 405 例患者使用静脉注射黏菌素的研究。大多数患者被诊断患有下呼吸道感染，其中主要病原体为鲍曼不动杆菌。黏菌素的剂量范围为 2.6 至 18mg/kg/天，只有 1 例报告了负荷剂量。在 2 例患者中报告了治疗过程中出现黏菌素耐药的情况。分别有 6.1%和 0.5%的患者出现了肾毒性和神经毒性，但由于同时使用了其他药物以及严重的基础疾病，我们无法明确将黏菌素的使用与肾毒性联系起来。总的病死率为 29.5%（95%CI 21.7%-38.1%），而感染相关的病死率为 16.6%（95%CI 12.2%-21.5%）。
虽然报告的与黏菌素相关的不良事件发生率较低，但 PICU 内多重耐药 GNB 感染的报告病死率值得关注。除了疾病的严重程度和合并症外，每日剂量不足和缺乏负荷剂量可能也是导致死亡的原因。随着黏菌素治疗多重耐药 GNB 感染的应用增加，有必要了解儿童患者中黏菌素的最佳剂量是否因年龄组而异。因此，有必要开展研究以确定不同儿科环境中黏菌素的药代动力学特征。
