Is It Safe To Use Levofloxacin For Treating Resistant Gram-Negatıve Bacterial Infections In The Pediatric Intensive Care Unit?

Abstract

Objective: Hospital-associated multidrug-resistant infections are currently on the rise. Widespread resistance to antibiotics and limited therapeutic options make it a challenge to eradicate these infections. Therefore, the use of different antibiotics was increased in pediatric intensive care (PICU). Fluoroquinolones belong to a class of broad-spectrum antimicrobials, and their use in children has not been associated with any known clinical complications. In this single-centre retrospective study, we aimed to evaluate the effects, results, and safety of levofloxacin treatment. Materials and Methods: A retrospective, single-center study was conducted at a local tertiary hospital involving 22 patients who were treated with levofloxacin in the PICU from July to December 2021. Levofloxacin was initiated at a dose of 10mg/kg twice daily intravenously for 14-21 days. The study examined and evaluated various factors related to the patients, including their demographic characteristics, medical history, comorbidities, length of stay, need for mechanical ventilation support, laboratory results, type of infection/microorganism, duration of treatment, treatment response and adverse effects, morbidity and mortality. Results: Stenotrophomonas maltophilia13(59.1%) and Pseudomonas aeruginosa9(40.9%) were detected in included patients who had levofloxacin treatment 20(90.9%) of their infections were eradicated. The mortality rate was found to be 13.6%, and 19 patients (86.4%) were successfully treated. No complications related to levofloxacin were detected during the treatment period. The duration of levofloxacin treatment in patients with eradication of gram negative bacteria was 21 days (range: 14-27 days), compared to 12 days (range: 10-14 days) in patients without eradication. This difference was found to be statistically significant (p=0.007). Conclusions: Due to the challenge of eradicating infections and the rising antibiotic resistance, it may be necessary to use antibiotics that are not typically prescribed to children or to develop new drug categories. Therefore, there is a need for more multicenter, randomized controlled, and long-term observational studies to evaluate the efficacy of different and new groups of antibiotics, including levofloxacin, in treating gram-negative bacterias.