colistin and Infant--Premature--Diseases

Topics: Anti-Bacterial Agents; Cephalosporins; Chloramphenicol; Colistin; Drug Hypersensitivity; Erythromycin; Gentamicins; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Infections; Intestinal Absorption; Kanamycin; Neomycin; Odontogenesis; Oleandomycin; Penicillin Resistance; Penicillins; Polymyxins; Staphylococcal Infections; Streptomycin; Tetracycline

Topics: Colistin; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases

To describe the efficacy of intravenous colistin on clinical and microbiological outcomes in preterm infants with nosocomial sepsis in neonatal intensive care unit (NICU) and define adverse events observed with this treatment.. The records of preterm infants who received colistin with or without positive cultures in the NICU were retrospectively reviewed. Patients were evaluated for response to therapy and side effects.. A total of 21 preterm infants with medians of 28 weeks (23-36) gestational age and 870 g (620-2,650) birth weight were included. The median duration and dose of colistin therapy were 9 days (3-26) and 3 mg/kg/d (2-5). Recovery rate in patients including all with/without positive culture was 81% (17/21). Microbiological clearance by colistin was 69% (9/13). The major side effect observed was acute kidney injury (19%). At least 24% of infants required electrolyte supplementation during the colistin therapy. Magnesium levels were significantly lower at the end of the colistin therapy (p < 0.001). Acute kidney injury and electrolyte disturbances including hypomagnesemia were reversible in all surviving patients.. We suggest that renal function tests and serum electrolytes should be monitored closely and replaced in case of any need during the colistin therapy in preterm infants.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Acute Kidney Injury; Administration, Intravenous; Anti-Bacterial Agents; Colistin; Cross Infection; Electrolytes; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intensive Care, Neonatal; Magnesium; Male; Microbial Sensitivity Tests; Retrospective Studies; Sepsis; Water-Electrolyte Imbalance

Ventilator-associated pneumonia (VAP) caused by Acinetobacter baumannii is increasing. It has a high mortality rate but experience in using inhaled colistin as monotherapy for VAP in children, especially pre-term infants, is limited. This study presents experiences using aerosolized colistin as monotherapy for VAP due to A. baumannii infection in pre-term infants.. Eight pre-term infants (gestational age 25-36 weeks) admitted to the neonatal intensive care unit (NICU) of Kaohsiung Chang Gung Memorial Hospital in Taiwan from January 2006 to December 2010 who received inhaled colistin as monotherapy for VAP due to A. baumannii infection were retrospectively evaluated. Of the isolated microorganisms, five were multi-drug resistant strains of A. baumannii (MDR-AB) but all were sensitive to colistin. All patients received inhaled colistin at a dose of 1,000,000 IU (33.4 mg) twice daily for an average of 9.1 days (range, 4-22 days).. All pre-term infants were cured, with A. baumannii eradicated from airway secretions. There were no clinical or laboratory adverse events related to colistin use.. Aerosolized colistin may be used as monotherapy for VAP due to A. baumannii infection in pre-term infants. A larger controlled study is warranted to corroborate the findings.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Administration, Inhalation; Anti-Bacterial Agents; Colistin; Female; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Pneumonia, Ventilator-Associated; Retrospective Studies

Acquired Bartter-like syndrome (BLS), characterized by hypokalemic metabolic alkalosis, hypomagnesemia, hypocalcemia, and normal kidney function, can be induced by diuretics or antibiotics. It is a very rare condition and only anecdotal cases mostly in adults were reported. Although tubulopathy associated with colistin was reported in adults, to the best of our knowledge, colistin-associated BLS neither in adults nor in children has been reported in the literature. We here report a-28-week, 740 g female preterm infant who developed BLS just after colistin treatment for Acinetobacter baumannii infection and recovered few days after the drug cessation, and discuss the possible association of colistin and tubulopathy. More research on colistin pharmacokinetics and pharmacodynamics in critically ill patients and preterm infants is needed to guide adequate colistin dosing at the least toxicity.

Topics: Adult; Anti-Bacterial Agents; Bartter Syndrome; Colistin; Enterocolitis, Necrotizing; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Kidney Diseases; Pregnancy

Multidrug-resistant (MDR) gram-negative bacteria-related nosocomial infections and ventilator-associated pneumonia (VAP) presents an emerging challenge to clinicians. Older antimicrobial agents such as colistin have become life-saving drugs because of the susceptibility of these pathogens. We report our experience with aerosolized colistin in two preterm and one term neonate with Acinetobacter baumannii and Pseudomonas aeruginosa-related VAP who were unresponsiveness to previous antimicrobial treatment. All pathogens were isolated from tracheal aspirate. We used 5 mg/kg (base activity) aerosolized colistin methanesulfonate sodium in every 12 h as an adjunctive therapy for VAP. VAP was treated by 14, 14, and 16-day courses of aerosolized colistin in these patients, respectively. No adverse effect such as nephrotoxicity or neurotoxicity was observed. We found that aerosolized colistin was tolerable and safe, and it may be an adjunctive treatment option for MDR gram-negative bacterial VAP in neonates. Further studies are needed to determine appropriate doses for aerosolized colistin and its eligibility as an alternative treatment choice in newborns.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Administration, Inhalation; Anti-Bacterial Agents; Colistin; Drug Administration Schedule; Drug Resistance, Multiple, Bacterial; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Pneumonia, Ventilator-Associated; Pseudomonas aeruginosa; Pseudomonas Infections; Retrospective Studies; Treatment Outcome

A premature neonate with severe Coxsackie B1 hepatitis acquired in utero developed disseminated intravascular coagulation a few days after birth. The neonate did not respond to conventional treatment. Eradication of aerobic gram-negative bacilli (Enterobacteriaceae) from the gut with oral nonabsorbable polymyxin E and tobramycin (selective decontamination of the digestive tract) was followed by clinical improvement; disseminated intravascular coagulation was controlled. After an unstable convalescence, the neonate recovered and was discharged in good general condition. A correlation between oral feeding, gut carriage of Enterobacteriaceae, fecal endotoxin pool, and platelet counts was observed. The eradication of gut carriage of aerobic gram-negative bacilli was associated with a significant decrease of the intestinal endotoxin pool and paralleled the recovery from thrombocytopenia. Selective decontamination is discussed as a method of possible value for controlling systemic endotoxin-induced symptoms in the critically ill with intestinal endotoxemia.

Topics: Administration, Oral; Cefuroxime; Colistin; Coxsackievirus Infections; Disseminated Intravascular Coagulation; Enterovirus B, Human; Gram-Negative Bacteria; Hepatitis, Viral, Human; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intestines; Tobramycin

In a Tunisian hospital 27 babies, including 12 who were premature, in a single intensive care unit suffered acute gastroenteritis in the period from January to May 1988. The mean age at the onset of gastroenteritis was 8.4 days; nine babies died. Salmonella wien was isolated from stools (all babies) and blood (4 babies). It was also isolated from the stools of one nurse and from a mattress. Twelve of the babies had received cefotaxime, which was successfully replaced by oral colimycin. The outbreak was stopped by the implementation of infection control measures. All isolates of Salmonella wien were of the same biotype, and had the same antibiotic resistance pattern (third generation cephalosporins, monobactams, aminoglycosides, chloramphenicol, trimethoprim and sulphonamides) and plasmid DNA restriction pattern. The isolates were all susceptible to a combination of cefotaxime and clavulanic acid (a beta-lactamase inhibitor), which displayed synergy, suggesting the presence of a beta-lactamase (geometric mean MICs 11.24 micrograms/ml for cefotaxime alone and 0.24 micrograms/ml in combination with 0.1 micrograms/ml potassium clavulanate). All isolates produced TEM-1 and SHV-2 beta-lactamase which was not transferable to Escherichia coli by conjugation. The presence of the SHV-2 enzyme in Salmonella wien may allow it to adapt to newer beta-lactams which is a cause for concern in this hospital.

Topics: Acute Disease; beta-Lactamases; Cefotaxime; Clavulanic Acid; Clavulanic Acids; Colistin; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Drug Synergism; Feces; Gastroenteritis; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intensive Care Units, Neonatal; Microbial Sensitivity Tests; Salmonella; Salmonella Infections; Tunisia

The effects of orally administered gentamicin and colistin on stool bacterial flora and overall antibiotic sensitivity patterns were evaluated in 100 newborns at risk for neonatal necrotizing enterocolitis. Gentamicin (2.5 mg/kg q6h) and colistin (1 mg/kg q6h) were administered to randomly selected groups of 50 newborns for 3 wk after birth during an 11-month study period. Stools were collected on days 1, 11, and 21 and cultures were grown under aerobic conditions on three different media. Staph. epidermidis was the most common predominant organism in both antibiotic groups, whereas E. coli and Klebsiella were the most common Gram-negative bacteria isolated. Seventeen % of these Gram-negative species were resistant to colistin and 9% to gentamicin, with a gradual increase occurring during the 3-wk period. On the basis of 980 positive cultures from all sites in babies in the nursery during the 11-month study, E. coli sensitivity to kanamycin and gentamicin ranged between 92% and 100% except for one month midway through the study when sensitivity to kanamycin was at 80% and then returned to the 92-100% range. Klebsiella sensitivity to both aminoglycosides remained greater than 95% throughout. The incidence of neonatal sepsis remained consistent at seven to nine per 1000 live births during the study. One baby of 50 in the gentamicin group developed necrotizing enterocolitis at 5 wk of age; 0/50 in the colistin group had necrotizing enterocolitis (not significant).

Topics: Colistin; Drug Resistance, Microbial; Enterocolitis, Pseudomembranous; Escherichia coli; Feces; Gentamicins; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Klebsiella; Risk; Staphylococcus

An epidemic caused by Serratia marcescens occurred in intensive care unit of the Children's clinic in Essen, with three deaths. Although there was good sensitivity of the strain to gentamicin in vitro, there was no noticeable clinical improvement when it was administered. But cotrimoxazole, given systemically and locally, and colistin locally cured the disease.

Topics: Colistin; Cross Infection; Disease Outbreaks; Enterobacteriaceae Infections; Gentamicins; Germany, West; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Intensive Care Units; Sepsis; Serratia marcescens; Sulfamethoxazole; Trimethoprim

Topics: Ampicillin; Anti-Bacterial Agents; Carbenicillin; Cephalothin; Chloramphenicol; Colistin; Dicloxacillin; Escherichia coli Infections; Gentamicins; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Pseudomonas Infections; Sepsis; Staphylococcal Infections; Streptococcal Infections

Topics: Ampicillin; Child, Preschool; Colistin; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Oxacillin; Pneumonia, Aspiration

Topics: Colistin; Cross Infection; Escherichia coli; Escherichia coli Infections; Humans; Infant, Newborn; Infant, Premature, Diseases; Italy

Topics: Colistin; Cross Infection; Disease Outbreaks; Female; France; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Polymyxins; Pseudomonas aeruginosa; Pseudomonas Infections

Topics: Adult; Colistin; Gentamicins; Humans; In Vitro Techniques; Infant; Infant, Newborn; Infant, Premature, Diseases; Polymyxins; Pseudomonas aeruginosa

Topics: Anti-Bacterial Agents; Bacitracin; Chloramphenicol; Colistin; Drug Therapy; Erythromycin; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Infant, Premature, Diseases; Kanamycin; Neomycin; Novobiocin; Penicillins; Polymyxins; Streptomycin; Tetracycline

Topics: Antibiotic Prophylaxis; Colistin; Diarrhea; Diarrhea, Infantile; Escherichia coli Infections; Gastroenteritis; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Vaccination

Topics: Anti-Bacterial Agents; Colistin; Cross Infection; Diarrhea, Infantile; Drug Resistance, Microbial; Escherichia coli Infections; Female; Furazolidone; Germany, West; Humans; Infant, Newborn; Infant, Premature, Diseases; Polymyxins; Pregnancy; Statistics as Topic

Topics: Colistin; Cross Infection; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Kanamycin; Klebsiella; Klebsiella Infections; Klebsiella pneumoniae; Meningitis; Ophthalmology; Oxytetracycline; Polymyxins

Topics: Anti-Bacterial Agents; Colistin; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases