Safety and effectiveness of colistin in a pediatric burn unit

Abstract

The increased incidence of infections by multidrug-resistant gram-negative bacteria, especially in critical care units, has required reevaluating the usefulness of old antibiotics such as colistin, from the polymyxin group. Its use in burned patients, especially in the pediatric population, has been scarcely studied.

Objective: To evaluate the efficacy and neurological and renal toxicity of colistin in patients under 18 years of age admitted to a burn unit in a high-complexity hospital. 

Patients and Method: uncontrolled prospective cohort study. All burned patients who received colistin in the period between May 2022 and October 2023, empirically or due to a documented infection, were included. Demographic data, burn characteristics, microbiological isolation, treatment, and evolution were evaluated. Renal function was evaluated every 72 hours and neurological manifestations were evaluated daily. 

Results: 15 patients who received colistin with a total of 23 indications were included. Median age: 6 years (range (r): 0.7 to 15.0). Median colistin dose: 5.5 mg/kg/day (r: 4.0-7.5). In 10 indications, it was a treatment directed to a documented microorganism; in the others, it was an empirical treatment. There were no cases of nephrotoxicity or neurological alterations. All patients progressed favorably, except one who died of causes other than infection and colistin administration. 

Conclusion: Colistin appears to be a safe and effective drug in the management of burned patients. Prospective studies are required with a control group and a larger number of patients, in addition to pharmacokinetic studies, to support these results reliably.