colistin and Seizures

Nosocomial infections caused by multidrug-resistant (MDR) microorganisms are a common problem around the world, especially in Intensive Care Units. The aim of this study was to investigate the efficacy and safety of colistin therapy in paediatric patients with severe nosocomial infections caused by MDR Gram-negative bacteria. There were 87 episodes in 79 paediatric Intensive Care Unit patients in five different hospitals; each patient was treated intravenously with colistin and evaluated. Of the 79 patients, 54.4% were male and the median age was 30 months. The most commonly isolated microorganism was Acinetobacter baumannii, the most common isolation site was tracheal aspirate fluid and the most common type of infection was ventilator-associated pneumonia. The mean colistin dose in patients without renal failure was 5.4 ± 0.6 mg/kg/day, the mean therapy duration was 17.2 ± 8.4 days and the favourable outcome rate was 83.9%. Serious side effects were seen in four patient episodes (4.6%) during therapy; two patients suffered renal failure and the others had convulsive seizures. Other patients tolerated the drug well. The infection-related mortality rate was 11.5% and the probability of death within the first 9 days of treatment was 10 times higher than after the first 9 days. In conclusion, this study suggests that colistin is effective in the treatment of severe nosocomial infections caused by MDR Gram-negative bacteria and is generally well tolerated by patients, even after relatively long-term use.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adolescent; Child; Child, Preschool; Colistin; Cross Infection; Drug Administration Schedule; Drug Evaluation; Drug Resistance, Multiple, Bacterial; Female; Humans; Infant; Intensive Care Units, Pediatric; Male; Pseudomonas aeruginosa; Pseudomonas Infections; Renal Insufficiency; Retrospective Studies; Seizures; Time Factors; Treatment Outcome

There has been a resurgence of interest in the use of colistin for the treatment of multidrug-resistant Gram-negative bacterial infections. A more favorable infection outcome is observed when colistin is used in combination with carbapenems. We present a patient with severe New Delhi metallo-β-lactamase-1 Escherichia coli infection who developed convulsions rapidly followed by acute respiratory muscle weakness and apnoea during treatment with colistin and meropenem. Chromatographic assay showed a "trough" colistin level that was approximately fourfold higher than previously reported maximum steady-state colistin plasma levels in critically ill patients. The patient's renal clearance never necessitated dose adjustments, suggesting that the observed high plasma colistin level might be due to impaired non renal elimination. Although meropenem itself has very low neurotoxic potential, its concomitant use with colistin may have elicited colistin neurotoxicity.

Topics: Anti-Bacterial Agents; Apnea; beta-Lactamases; Chromatography; Colistin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Humans; Male; Meropenem; Middle Aged; Plasma; Seizures; Thienamycins

Topics: Brain Diseases; Child; Colistin; Gentamicins; Humans; Injections, Intravenous; Male; Osteomyelitis; Patella; Pseudomonas aeruginosa; Seizures

Topics: Anti-Bacterial Agents; Anticonvulsants; Brain Diseases; Burns; Child; Colistin; Coma; Drug Therapy; Electroencephalography; Humans; Neurologic Manifestations; Seizures

Topics: Anti-Bacterial Agents; Bacteriological Techniques; Cerebrospinal Fluid; Chloramphenicol; Colistin; Coma; Diagnosis; Epidemiology; Erythromycin; Listeria; Listeria monocytogenes; Meningitis; Meningitis, Listeria; Novobiocin; Oleandomycin; Oxytetracycline; Penicillins; Seizures; Sepsis; Serologic Tests; Spiramycin; Sulfonamides; Tetracycline