Antimicrobial resistance (AMR) among Gram-negative (GN) pathogens has emerged as a critical global threat, particularly in low- and middle-income countries where access to novel antimicrobials is limited. In Türkiye, colistin (CST) remains a last-resort therapy against multidrug-resistant (MDR) and carbapenem-resistant Gram-negative bacteria (CR-GNB) despite its nephrotoxic potential. This study aimed to evaluate the clinical characteristics, microbiological outcomes, and adverse events associated with CST therapy in pediatric patients over a nine-year period. We conducted a single-center retrospective cohort study including pediatric patients treated with CST for nosocomial MDR-GN infections at a tertiary university hospital between January 2016 and March 2025. Demographic, clinical, microbiological, and treatment-related data were collected. Univariable comparisons and multivariable logistic regression analyses were performed to identify factors associated with nephrotoxicity, treatment failure, and mortality. A total of 117 treatment episodes were identified among 112 patients (mean age: 75.9 ± 69.5 months; 65% male). The predominant pathogens were Klebsiella pneumoniae (39.7%), Pseudomonas aeruginosa (26.4%), and Acinetobacter baumannii (22.0%). CST was used in combination regimens in all episodes, most commonly with carbapenems (73.5%). Microbiological eradication was achieved in 70% of culture-confirmed episodes. The overall sepsis-related mortality rate was 18.8%. Nephrotoxicity occurred in 12.8% of patients and was associated with mortality and severity indicators in univariable analyses. In multivariable analysis, endotracheal intubation remained the only independent predictor of mortality (adjusted OR 23.98, 95% CI 4.47–128.52). Conclusions: CST remains a last-resort agent for MDR and CR-GNB infections in pediatric settings with limited access to novel antimicrobials. Although microbiological eradication was achieved in most cases, treatment outcomes were primarily driven by disease severity and host-related factors rather than antimicrobial combinations. Endotracheal intubation emerged as the strongest independent predictor of mortality.<Table Float="No" ID="Taba"> <tgroup cols="4"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <colspec align="left" colname="c3" colnum="3" /> <colspec align="left" colname="c4" colnum="4" /> <tbody> <row> <entry nameend="c4" namest="c1"> What is Known – What is New •CST is widely used as a last-resort option for pediatric MDR-GN infections. •Nephrotoxicity and variable clinical outcomes remain major concerns. •This study provides long-term real-world pediatric data on CST use. • Disease severity and host-related factors were the main determinants of treatment failure and mortality. </entry> </row> </tbody> </tgroup> </Table>

Real-world outcomes and safety of colistin therapy in children with multidrug-resistant gram-negative infections: a nine-year experience

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2026年3月20日

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Nesli Ağralı Eröz,
Zümrüt Şahbudak Bal,
Kübra Cebeci,
Gülizar Turan,
Nihal Karadaş,
Deniz Yılmaz Karapınar,
Ezgi Kıran Taşçı,
Miray Karakoyun,
Gökçen Kartal Öztürk,
Gülcihan Özek,
Coskun Ekemen,
Asli Arslan,
Melike Yaşar Duman,
Feriha Çilli,
Gülhadiye Avcu

摘要

Antimicrobial resistance (AMR) among Gram-negative (GN) pathogens has emerged as a critical global threat, particularly in low- and middle-income countries where access to novel antimicrobials is limited. In Türkiye, colistin (CST) remains a last-resort therapy against multidrug-resistant (MDR) and carbapenem-resistant Gram-negative bacteria (CR-GNB) despite its nephrotoxic potential. This study aimed to evaluate the clinical characteristics, microbiological outcomes, and adverse events associated with CST therapy in pediatric patients over a nine-year period. We conducted a single-center retrospective cohort study including pediatric patients treated with CST for nosocomial MDR-GN infections at a tertiary university hospital between January 2016 and March 2025. Demographic, clinical, microbiological, and treatment-related data were collected. Univariable comparisons and multivariable logistic regression analyses were performed to identify factors associated with nephrotoxicity, treatment failure, and mortality. A total of 117 treatment episodes were identified among 112 patients (mean age: 75.9 ± 69.5 months; 65% male). The predominant pathogens were Klebsiella pneumoniae (39.7%), Pseudomonas aeruginosa (26.4%), and Acinetobacter baumannii (22.0%). CST was used in combination regimens in all episodes, most commonly with carbapenems (73.5%). Microbiological eradication was achieved in 70% of culture-confirmed episodes. The overall sepsis-related mortality rate was 18.8%. Nephrotoxicity occurred in 12.8% of patients and was associated with mortality and severity indicators in univariable analyses. In multivariable analysis, endotracheal intubation remained the only independent predictor of mortality (adjusted OR 23.98, 95% CI 4.47–128.52).

Conclusions: CST remains a last-resort agent for MDR and CR-GNB infections in pediatric settings with limited access to novel antimicrobials. Although microbiological eradication was achieved in most cases, treatment outcomes were primarily driven by disease severity and host-related factors rather than antimicrobial combinations. Endotracheal intubation emerged as the strongest independent predictor of mortality.

What is Known – What is New

•CST is widely used as a last-resort option for pediatric MDR-GN infections.

•Nephrotoxicity and variable clinical outcomes remain major concerns.

•This study provides long-term real-world pediatric data on CST use.

• Disease severity and host-related factors were the main determinants of treatment failure and mortality.