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A retrospective study on the effects of colistin therapy in children with multidrug-resistant Gram-negative bacterial pathogens: impact of HIV status on outcome
  1. Konstantinos Dimitriades1,2,
  2. Brenda May Morrow2,
  3. Prakash Jeena1
  1. 1Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Inkosi Albert Luthuli Central Hospital, Durban, KwaZulu-Natal, South Africa
  2. 2Department of Paediatric and Child Health, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, Western Cape, South Africa
  1. Correspondence to Professor Prakash Jeena, Department of Paediatrics and Child Health, University of KwaZulu-Natal, Private Bag X1, Congella, Durban, KwaZulu-Natal 4013, South Africa; jeena{at}ukzn.ac.za

Abstract

Background Nosocomially acquired multidrug-resistant (MDR) Gram-negative bacteria are important contributors to paediatric intensive care unit (PICU) mortality and morbidity, with limited treatment options.

Aim To investigate the outcomes of all children treated with colistin for infection with MDR Gram-negative bacteria while admitted to PICU.

Methods Retrospective observational study of 19 months. Primary endpoints were all-cause intensive care unit mortality and safety. Secondary endpoints evaluated clinical and microbiological outcomes. Cases were stratified according to HIV status.

Results Twenty-seven children received 30 colistin courses during the study period. Eight patients (29.6%) were HIV infected, six (22.2%) were HIV uninfected but exposed, and 11 (40.7%) were HIV uninfected and unexposed. Common MDR Gram-negative bacteria cultured were: Acinetobacter species (n=22, 81.5%), Pseudomonas aeruginosa (n=11, 40.7%) and Klebsiella pneumoniae (n=7, 25.9%). Mortality was 37%, with no significant difference between HIV strata. No adverse drug reactions were noted. A composite clinical improvement was noted in 16 courses (53.3%) of colistin. Only 30% of colistin courses used in HIV-infected children resulted in an improved clinical assessment as compared with 83.3% of courses in HIV-uninfected/unexposed children (p=0.04). In HIV-infected children, five of 10 (50%) courses of colistin showed bacteriological clearance compared to the HIV uninfected/unexposed group where all cases showed bacterial eradication (p=0.02).

Conclusions HIV-infected children had poorer clinical and bacteriological responses to colistin treatment than HIV uninfected/unexposed. These results require confirmation with prospective studies to determine whether findings are due to poor microbial response, immunodeficiency or repeated reinfections.

  • Colistin
  • Multidrug resistant gram negative bacteria
  • HIV
  • Outcome

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