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The Use of Intravenous Colistin Among Children in the United States: Results From a Multicenter, Case Series

Tamma, Pranita D. MD*; Newland, Jason G. MD; Pannaraj, Pia S. MD; Metjian, Talene A. PharmD§; Banerjee, Ritu MD, PhD; Gerber, Jeffrey S. MD, PhD; Weissman, Scott J. MD**; Beekmann, Susan E. RN, MPH††; Polgreen, Philip M. MD‡‡; Hersh, Adam L. MD, PhD§§

The Pediatric Infectious Disease Journal: January 2013 - Volume 32 - Issue 1 - p 17–22
doi: 10.1097/INF.0b013e3182703790
Original Studies

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.

From the *Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD; Division of Pediatric Infectious Diseases, Children’s Mercy Hospital, Kansas City, MO; Division of Pediatric Infectious Diseases, Children’s Hospital of Los Angeles, Los Angeles, CA; §Department of Antimicrobial Stewardship, The Children’s Hospital of Philadelphia, Philadelphia, PA; Department of Pediatric and Adolescent Medicine, Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, MN; Department of Pediatrics, Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, PA; **Department of Pediatrics, Division of Infectious Diseases, Seattle Children’s Hospital, Seattle, WA; ††Emerging Infection Network Program Coordinator; ‡‡Department of Medicine, Division of Infectious Diseases, University of Iowa Carver ­College of Medicine, Iowa City, IA; and §§Department of Pediatrics, Division of Infectious Diseases, University of Utah, Salt Lake City, UT.

Accepted for publication May 01, 2012.

This work was supported by a National Institutes of Health grant (grant number KL2RR025006 to PDT).

The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Pranita D. Tamma, MD, Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins Medical Institutions, 200 North Wolfe Street, Suite 3155, Baltimore, MD 21287. E-mail: ptamma1@jhmi.edu.

© 2013 Lippincott Williams & Wilkins, Inc.