Treatment Outcomes and Associated Factors of Intravenous Colistin for Nosocomial Infections in Pediatric Patients: A Retrospective Study in a University Hospital in Thailand

Abstract

Background: This study aimed to investigate the efficacy and safety of intravenous colistin in pediatric patients with nosocomial gram-negative bacteria infections and to determine factors associated with treatment outcomes. Methods: This retrospective study recruited patients aged <18 years receiving intravenous colistin between January 2014 and December 2018. Clinical data and treatment outcomes were reviewed, and factors associated with treatment outcomes were assessed. Results: This study included 178 patients with a median age of 3.4 years (range, 0.1–17.8). The mean ± SD dose of colistin prescribed to patients without renal impairment was 5.1 ± 0.6 mg/kg/day. The clinical response rate was 70.8% in patients receiving colistin for specific treatment. Infection-related mortality and crude mortality were 17.5% and 19.7%, respectively. The nephrotoxicity rate was 29.8%; approximately 70% of the episodes occurred between the 3rd and 7th day of treatment. The presence of at least 2 organ dysfunctions [adjusted hazard ratio (aHR): 7.17; 95% CI: 1.64–31.40], septic shock (aHR: 2.69; 95% CI: 1.36–5.32) and receiving chemotherapy/immunosuppressants (aHR: 2.68; 95% CI: 1.36–5.25) were observed to be associated with clinical failure. The factors observed to be associated with nephrotoxicity included hypoalbuminemia (aHR: 2.93; 95% CI: 1.26–6.78), receiving amphotericin B (aHR: 2.29; 95% CI: 1.16–4.52), vancomycin (aHR: 3.36; 95% CI: 1.50–7.56) and vasopressors (aHR: 2.57; 95% CI: 1.27–5.21). Conclusion: Colistin is generally effective in the treatment of nosocomial gram-negative bacteria infections in pediatric patients. Close monitoring of renal function should be considered, especially in high-risk patients. Optimal dosage regimens for pediatric populations to promote more favorable clinical outcomes and minimize nephrotoxicity require further investigation.