Abstract
In the past decade, multidrug-resistant (MDR) gram-negative bacteria have become a major problem, especially for patients in intensive care units. Recently, colistin became the last resort therapy for MDR gram-negative bacteria infections. However, nebulised colistin use was limited to adult patients. Thus, we investigated the efficacy and safety of nebulised colistin treatment against MDR microorganisms in the paediatric intensive care unit (PICU). Data of all patients admitted for various critical illnesses (January 2016 to January 2019) were reviewed. Differences between groups (with and without a history of nebulised colistin) were compared. Of 330 patients, 23 (6.97%) used nebulised colistin. Significant relationships were found between nebulised colistin usage and several prognostic factors (inotropic drug use (p = 0.009), non-invasive mechanical ventilation (p ≤ 0.001), duration in PICU (p ≤ 0.001), and C-reactive protein level (p = 0.003)). The most common microorganism in tracheal aspirate and sputum cultures was Pseudomonas aeruginosa (13 patients). The most common underlying diagnosis was cystic fibrosis, noted in 6 patients. No serious nephrotoxicity and neurotoxicity occurred. This study showed that colistin can be safely used directly in the airway of critically ill children. However, nebulised colistin use did not have a positive effect on mortality and prognosis.
Highlights
In the past decade, multidrug-resistant (MDR) gram-negative bacteria have become a major problem, especially among patients in intensive care units [1]
A bacteriological and clinical response to nebulised colistin use was observed in 22 patients, and mortality only occurred in a female patient who had end-stage cystic fibrosis
We found a significant relationship between nebulised colistin and increased C-reactive protein (CRP) levels and Paediatric Risk of Mortality (PRISM) scores
Summary
Multidrug-resistant (MDR) gram-negative bacteria have become a major problem, especially among patients in intensive care units [1]. A World Health Organization (WHO) report showed that antimicrobial resistance was increasing worldwide [2]. The virulence of these MDR infectious agents severely restricts viable therapeutic options. Polymyxin E (colistin) was first used in the 1960s, and it has since been used for treating infections caused by gram-negative bacteria. Colistin was a last resort therapy for infections caused by MDR gram-negative bacteria, in particular Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae [3,4,5]. Most of the published experience of colistin as a treatment of pneumonia involved parenteral administration [5]
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