The use of intravenous colistin among children in the United States: results from a multicenter, case series.
The use of intravenous colistin among children in the United States: results from a multicenter, case series.
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在美国儿童中使用静脉内结肠蛋白：来自多中心，病例系列的结果。
DOI：
10.1097/inf.0b013e3182703790
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发表时间：
2013-01
期刊：
影响因子：
--
通讯作者：
Hersh AL
中科院分区：
文献类型：
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作者：
Tamma PD;Newland JG;Pannaraj PS;Metjian TA;Banerjee R;Gerber JS;Weissman SJ;Beekmann SE;Polgreen PM;Hersh AL
耐多药革兰氏阴性感染的迅速增加导致全球重新出现粘菌素的使用。虽然在成人中有很好的描述，但粘菌素在儿童中的使用及其相关毒性知之甚少。我们报告了迄今为止儿童使用粘菌素的最大病例系列的发现。我们询问了来自新发感染网络的儿科传染病专家，以确定在过去7年内静脉注射粘菌素的成员。我们收集了相关的人口统计学和临床资料。进行了双变量分析和多变量logistic回归。229名儿科传染病专家完成了调查（84%的回复率）；22%的人给儿童开过粘菌素。在答复者中，提交了来自25家机构的92例粘菌素使用病例。最常见的目标生物是耐多药假单胞菌（67.4%）、耐多药鲍曼不动杆菌（11.9%）、产碳青霉烯酶肠杆菌科（13.0%）和产广谱β-内酰胺酶肠杆菌科（5.4%）。20.5%的患者出现粘菌素耐药性。84%的患者接受了额外的抗菌治疗，22%的儿童出现肾毒性（与规定的粘菌素剂量或间隔时间无关）。所有患者的肾功能均恢复到基线水平。≥13岁儿童发生肾毒性的几率大约是年幼儿童的7倍，即使在接受额外肾毒性药物的控制后也是如此（优势比7.16；95%可信区间：1.51-14.06;P = 0.013）。4名儿童表现出可逆性神经毒性。大多数儿科传染病专家没有开具粘菌素处方的经验。粘菌素在儿童中的使用主要与肾毒性有关，在较小程度上与神经毒性有关，这两种毒性都是可逆的。粘菌素耐药性的出现令人担忧。
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. 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. 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. 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.