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Efficacy of colistin in multidrug-resistant neonatal sepsis: experience from a tertiary care center in Karachi, Pakistan
  1. Gul Ambreen1,
  2. Muhammad Sohail Salat2,
  3. Kashif Hussain1,
  4. Syed Shamim Raza1,
  5. Umer Ali1,
  6. Iqbal Azam3,
  7. Junaid Iqbal2,
  8. Zafar Fatmi3
  1. 1Pharmacy, Aga Khan University Hospital, Karachi, Pakistan
  2. 2Pediatric and Child Health, Aga Khan University, Karachi, Pakistan
  3. 3Community Health Sciences, Aga Khan University, Karachi, Pakistan
  1. Correspondence to Dr Gul Ambreen, Pharmacy, Aga Khan University, Karachi 74800, Pakistan; gul.ambreen{at}aku.edu

Abstract

Objective Infections with multidrug-resistant organisms (MDROs) such as Gram-negative bacteria have high morbidity and mortality with limited treatment options. Colistin, an antibiotic active against MDRO, was rarely used due to frequent adverse effects, but its use has now been recommended among adults. In this study, we determined the efficacy of colistin for the treatment of sepsis in neonates.

Design/setting/patients/outcomes We conducted a retrospective record review of all neonates admitted to the neonatal intensive care unit of Aga Khan University Hospital, Karachi, Pakistan, between June 2015 and June 2018, who had sepsis and received colistin by intravenous, inhalation and/or intrathecal routes. Predictors of colistin efficacy, for neonatal survival and microbial clearance, were assessed using multiple logistic regression.

Results 153 neonates received colistin; 120 had culture-proven sepsis; and 93 had MDR-GNB (84 colistin-sensitive). 111 (72.5%) neonates survived and were discharged from hospital; 82.6% had microbial clearance. Neonates with colistin-sensitive bacteria (adjusted OR (AOR)=3.2, 95% CI 2.8 to 4.0), and those in which colistin therapy started early (AOR=7.2, 95% CI 3.5 to 13.6) were more likely to survive. Neonates with increased gestational age (AOR=1.9, 95% CI 1.5 to 3.0), higher weight (AOR=5.4, 95% CI 3.3 to 11.8) and later onset of sepsis (AOR=4.3, 95% CI 2.0 to 9.0) had higher survival. Adverse events included nephrotoxicity in 5.2%; 13.7% developed seizures and 18.3% had electrolyte imbalance.

Conclusions Colistin therapy was associated with survival among neonates suffering from MDR-GNB sepsis. The frequency of side effects was moderate.

  • infectious diseases
  • mortality
  • intensive care
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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained before starting this study from the Ethical Review Committee (ERC) of Aga Khan University, Karachi, Pakistan (ERC # 2018-0233-137).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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