2437. Colistin Usage, Do We Need to Worry About Its Toxicity Among Children With Cancer?

Abstract

BackgroundGram-negative bacteria susceptible only to colistin are emerging causes of complicated infections especially in the immunocompromised patients, reviving interest in the use of colistin. The purpose of this study was to test the renal toxicity along with efficacy of a salvage therapy with a colistin among pediatric cancer patients in our hospital.MethodsA prospective, observational, cohort study was performed from May 2017 to October 2017 in Children’s cancer hospital Egypt 57357. All patients who had Blood Stream Infections due to COS Gram-negative bacteria and received intravenous Colistin were prospectively enrolled. A standardized case form was used to record patient characteristics, including age, sex, weight, underlying comorbidities, type of infection, causative organism and in vitro susceptibility, daily doses and duration of colistin therapy, cumulative dose of colistin, co-administered antibiotics, nephrotoxic agents, and clinical and microbiological responses to therapy, daily serum creatinine clearance, and estimated creatinine clearance were recorded.ResultsOne hundred and Thirty-four Blood Stream infectious episodes due to Klebsiella species (pneumoniae and Oxytoca) (32%), and E. coli (68%) were analyzed. All strains were fully susceptible to colistin, with MICs of 0.19–1.5 mg/L. It was employed as combination therapy with carbapenems (69.2%) or aminoglycosides (30.8%). Median duration of treatment was 9 days (range 1–50 days). Clinical and Microbiological cure was observed in 107 cases (80%). Acute kidney injury developed during 5 treatment courses (4%)in combination with Amikacin. No renal replacement therapy was required and subsided within 7 days from Colistin discontinuation. No correlation was found between variation in serum creatinine level (from base line to peak) and daily and cumulative doses of CMS.ConclusionOur study shows that in severe infections due to COS Gram-negative bacteria, Colistin had a high efficacy, without significant renal toxicity. Looking into the failure of microbiological cure, we need to further study the possibility of increasing the Colistin with cautious monitoring of renal functions, and Therapeutic Drug monitoring. Furthermore, the bacterial isolates should be studied at the genetic level for resistance.Disclosures All authors: No reported disclosures.