213. Intravenous Colistin for Multidrug Resistent Gram Negative Bacteria in Pediatric Patients
Session: Poster Abstract Session: Antimicrobial Resistance: Clinical Studies
Friday, October 21, 2011
Room: Poster Hall B1
Background: 

The emergence of multidrug (MDR) resistant gram negative bacteria has led to a renewed interest in the safety and efficacy of colistin.

Methods: 

We reviewed our experience with intravenous colistin in pediatric patients admitted to Children’s Hospital Los Angeles between January 1, 2005 and October 31, 2010.

Results: 

Fifty-three children received intravenous or nebulized colistin for treatment or suppressive therapy against MDR bacteria. We present here 14 children who received 18 courses of intravenous colistin as treatment. Almost half (n=8) of the treatment courses occurred in 2010. Age ranged from 2 to 20 years (mean, 15.5 years). Underlying conditions included 8 cystic fibrosis (CF), 3 non-CF chronic lung disease, 1 malignancy, and 2 previously healthy children with prolonged hospitalizations. All children had been hospitalized during the preceding calendar year with total hospitalization days ranging from 2 to 225 days (mean, 95.8 days) during which they received an average of 4.5 antibiotics (range, 2-10) accounting for 272.7 antibiotic days (range, 83-656 days). The indications for colistin therapy were pulmonary exacerbation (n=9), wound infection (n=4), bacteremia/sepsis (n=4), and chronic diarrhea (n=1). Acinetobacter baumanii (n=6) or Pseudomonas aeruginosa (n=16) grew from clinical specimens. They received an average of 2.3 mg/kg (range, 1.6-4.9 mg/kg) for 13.8 days (range, 4-41 days). Creatinine levels increased two-fold in two children during therapy; one was receiving concomitant aminoglycoside and required early cessation of both antimicrobials. The second patient completed her course uninterrupted. Two children developed neurologic symptoms: one with perioral tingling requiring early termination and another with headache that resolved after the colistin course was completed.  

Conclusion: 

This study underscores the growing impact of antimicrobial selective pressure in high risk pediatric patients and adds to the clinical experience of colistin use in children.   More studies on dosing and safety of colistin are necessary to inform optimal usage in children.


Subject Category: A. Antimicrobial agents and Resistance

Pia Pannaraj, MD, MPH1, Jim Hung, BS2, Hailin Wang, MPH2 and Melanie George3, (1)Infectious Diseases, Univerisity of Southern California and Children's Hospital Los Angeles, Los Angeles, CA, (2)Children's Hospital Los Angeles, Los Angeles, CA, (3)Pharmacy, Children's Hospital Los Angeles, Los Angeles, CA

Disclosures:

P. Pannaraj, None

J. Hung, None

H. Wang, None

M. George, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.