Intravenous colistin use for infections due to MDR Gram-negative bacilli in critically ill paediatric patients: a systematic review and meta-analysis

2019 ◽  
Vol 74 (9) ◽  
pp. 2497-2506 ◽  
Author(s):  
Spyridon A Karageorgos ◽  
Hamid Bassiri ◽  
George Siakallis ◽  
Michael Miligkos ◽  
Constantinos Tsioutis
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Meta Analysis ◽  
Age Groups ◽  
Clinical Effectiveness ◽  
Loading Dose ◽  
Gram Negative ◽  
Paediatric Patients ◽  
Optimal Dosing ◽  
Tract Infections

Abstract Background Data are limited regarding the clinical effectiveness and safety of intravenous colistin for treatment of infections due to MDR Gram-negative bacilli (GNB) in paediatric ICUs (PICUs). Methods Systematic review of intravenous colistin use in critically ill paediatric patients with MDR-GNB infection in PubMed, Scopus and EMBASE (up to 31 January 2018). Results Out of 1181 citations, 7 studies were included on the use of intravenous colistin for 405 patients in PICUs. The majority of patients were diagnosed with lower respiratory tract infections, Acinetobacter baumannii being the predominant pathogen. Colistin dosages ranged between 2.6 and 18 mg/kg/day, with only one case reporting a loading dose. Emergence of colistin resistance during treatment was reported in two cases. Nephrotoxicity and neurotoxicity were reported in 6.1% and 0.5%, respectively, but concomitant medications and severe underlying illness limited our ability to definitively associate use of colistin with nephrotoxicity. Crude mortality was 29.5% (95% CI = 21.7%–38.1%), whereas infection-related mortality was 16.6% (95% CI = 12.2%–21.5%). Conclusions While the reported incidence of adverse events related to colistin was low, reported mortality rates for infections due to MDR-GNB in PICUs were notable. In addition to severity of disease and comorbidities, inadequate daily dosage and the absence of a loading dose may have contributed to mortality. As the use of colistin for treatment of MDR-GNB infections increases, it is imperative to understand whether optimal dosing of colistin in paediatric patients differs across different age groups. Thus, future studies to establish the pharmacokinetic properties of colistin in different paediatric settings are warranted.

scholarly journals Intravenous colistin use for infections due to multidrug-resistant gram-negative bacilli in critically ill paediatric patients: a systematic review and meta-analysis

2018 ◽  
Author(s):  
Spyridon A. Karageorgos ◽  
Hamid Bassiri ◽  
George Siakallis ◽  
Michael Miligkos ◽  
Constantinos Tsioutis
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Meta Analysis ◽  
Age Groups ◽  
Clinical Effectiveness ◽  
Multidrug Resistant ◽  
Loading Dose ◽  
Gram Negative ◽  
Paediatric Patients ◽  
Tract Infections

SynopsisBackgroundData are limited regarding the clinical effectiveness and safety of intravenous colistin for treatment of infections by multidrug-resistant gram-negative bacilli (MDR-GNB) in the paediatric intensive care unit (PICU).MethodsSystematic review of intravenous colistin use in critically ill paediatric patients with MDR-GNB infection in PubMed, Scopus and Embase (through January 31st, 2018).ResultsOut of 1,181 citations, 7 studies were included on the use of intravenous colistin for 405 patients in PICU. Majority of patients were diagnosed with lower respiratory tract infections, with Acinetobacter baumannii being the predominant pathogen. Colistin dosages ranged between 2.6-18 mg/kg/day, with none but one case reporting a loading dose. Emergence of colistin-resistance during treatment was reported in two cases. Nephrotoxicity and neurotoxicity were reported in 6.1% and 0.5% respectively, but concomitant medications and severe underlying illness limited our ability to definitively associate use of colistin with nephrotoxicity. Crude mortality was 29.5% (95%CI 21.7-38.1%), whereas infection-related mortality was 16.6% (95%CI 12.2-21.5%).ConclusionsWhile the reported incidence of adverse events related to colistin were low, reported mortality rates for infections by MDR-GNB in PICU were notable. In addition to severity of disease and comorbidities, inadequate daily dosage and the absence of a loading dose may have contributed to mortality. As the use of colistin for treatment of MDR-GNB infections increases, it is imperative to understand whether optimal dosing of colistin in paediatric patients differs across different age groups. As such, future studies to establish the pharmacokinetic properties of colistin in different paediatric settings are warranted.

scholarly journals Xyloglucan, Hibiscus and Propolis in the Management of Uncomplicated Lower Urinary Tract Infections: A Systematic Review and Meta-Analysis

Antibiotics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 14
Author(s):  
Tommaso Cai ◽  
Umberto Anceschi ◽  
Irene Tamanini ◽  
Serena Migno ◽  
Michele Rizzo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medical Device ◽  
Meta Analysis ◽  
Clinical Effectiveness ◽  
Adult Women ◽  
End Of Treatment ◽  
Significant Difference ◽  
Clinically Significant ◽  
Tract Infections ◽  
Uncomplicated Cystitis

Background: In the era of antibiotic resistance, an antibiotic-sparing approach presents an interesting alternative treatment of uncomplicated cystitis in women. Our aim is to perform a systematic review and meta-analysis to compare the effectiveness and safety profile of a medical device containing xyloglucan, hibiscus and propolis (XHP) in women with uncomplicated cystitis. Methods: Relevant databases were searched using methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The primary endpoint was clinical or microbiological success, defined as the complete (cure) and/or non-complete (improvement) resolution of symptoms at the end of treatment, or microbiological resolutions. Results: After screening 21 articles, three studies were included, recruiting a total of 178 patients. All three studies used placebo as comparator. A statistically significant difference was found in terms of clinical or microbiological resolution between the medical device and the comparator (3 RCTs, 178 patients, OR: 0.13; 95% CI: 0.05–0.33; p < 0.0001). No clinically significant adverse effects have been reported. Conclusion: A medical device containing xyloglucan, hibiscus and propolis is superior to comparator regimens in terms of clinical effectiveness in adult women with microbiologically confirmed or clinical suspicion of uncomplicated cystitis and is associated with a high patient compliance.

scholarly journals Modifiable risk factors for multidrug‐resistant Gram‐negative infection in critically ill burn patients: a systematic review and meta‐analysis

2019 ◽  
Vol 89 (10) ◽  
pp. 1256-1260 ◽  
Author(s):  
Mark L. Vickers ◽  
Eva Malacova ◽  
Gabriel J. Milinovich ◽  
Patrick Harris ◽  
Lars Eriksson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Critically Ill ◽  
Meta Analysis ◽  
Multidrug Resistant ◽  
Modifiable Risk Factors ◽  
Burn Patients ◽  
Gram Negative

scholarly journals Inhalation with intravenous loading dose of colistin in critically ill patients with pneumonia caused by carbapenem-resistant gram-negative bacteria

2019 ◽  
Vol 13 ◽  
pp. 175346661988552 ◽  
Author(s):  
Junsu Choe ◽  
You Min Sohn ◽  
Suk Hyeon Jeong ◽  
Hyo Jung Park ◽  
Soo Jin Na ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Gram Negative Bacteria ◽  
Loading Dose ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Optimal Dosing ◽  
Microbiological Outcome ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Background: Despite the increasing use of colistin in clinical practice, the optimal dosing, and administration route have not been established. This study aimed to evaluate the clinical outcome and safety of intravenous (IV) colistin with a loading dose (LD) and adjunctive aerosolized (AS) colistin administration in critically ill patients with hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP) caused by carbapenem-resistant gram-negative bacteria (CRGNB). Methods: We retrospectively reviewed 191 critically ill patients who received colistin for the treatment of HAP or VAP caused by CRGNB. Patients were divided into three groups: non-LD IV (patients received only IV colistin without LD), LD IV (patients received only IV colistin with LD), and AS–LD (patients received IV colistin with LD and adjunctive AS colistin). Results: There was no difference in clinical response between the three groups. However, the rate of microbiological eradication was significantly higher in the AS–LD group (60%) than in the non-LD IV (31%), and LD IV (33%) groups ( p = 0.010). Patients treated with adjunctive AS colistin in combination with LD IV had significantly lower 30-day mortality rates than patients treated with IV colistin alone ( p = 0.027). After adjusting for potential confounding factors, adjunctive AS colistin was still significantly associated with lower mortality (adjusted OR 0.338, CI 95% 0.132–0.864, p = 0.024). However, nephrotoxicity did not change according to the use of LD regimen and AS colistin administration ( p = 0.100). Conclusions: Adjunctive AS colistin in combination with IV colistin with LD was related to an improved 30-day mortality and microbiological outcome without an increase in nephrotoxicity in critically ill patients with HAP and VAP caused by CRGNB. The reviews of this paper are available via the supplemental material section.

scholarly journals Importance of vitamin D in acute and critically ill children with subgroup analyses of sepsis and respiratory tract infections: a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e027666 ◽  
Author(s):  
Margarita Cariolou ◽  
Meghan A Cupp ◽  
Evangelos Evangelou ◽  
Ioanna Tzoulaki ◽  
Antonio J Berlanga-Taylor
Keyword(s):  
Systematic Review ◽  
Respiratory Tract ◽  
Critically Ill ◽  
Respiratory Tract Infections ◽  
Meta Analysis ◽  
Small Study ◽  
Critical Conditions ◽  
Critically Ill Children ◽  
Pooled Prevalence ◽  
Tract Infections

ObjectivesTo estimate the prevalence of 25-hydroxyvitamin D (25(OH)D) deficiency and investigate its association with mortality in children with acute or critical conditions.DesignSystematic review and meta-analysis of observational studies.Data sourcesPubMed, OVID, Google Scholar and the Cochrane Library searched until 21 December 2018.Eligibility criteriaStudies of children hospitalised with acute or critical conditions who had blood 25(OH)D levels measured.Data extraction and synthesisWe obtained pooled prevalence estimates of 25(OH)D deficiency and ORs for mortality. We calculated 95% CI and prediction intervals and investigated heterogeneity and evidence of small-study effects.ResultsFifty-two studies were included. Of 7434 children, 3473 (47.0%) were 25(OH)D deficient (<50 nmol/L). The pooled prevalence estimate of 25(OH)D deficiency was 54.6% (95% CI 48.5% to 60.6%, I2=95.3%, p<0.0001). Prevalence was similar after excluding smaller studies (51.5%). In children with sepsis (18 studies, 889 total individuals) prevalence was 64.0% (95% CI 52.0% to 74.4%, I2=89.3%, p<0.0001) and 48.7% (95% CI 38.2% to 59.3%; I2=94.3%, p<0.0001) in those with respiratory tract infections (RTI) (25 studies, 2699 total individuals). Overall, meta-analysis of mortality (18 cohort studies, 2463 total individuals) showed increased risk of death in 25(OH)D deficient children (OR 1.81, 95% CI 1.24 to 2.64, p=0.002, I2=25.7%, p=0.153). Four (22.0%) of the 18 studies statistically adjusted for confounders. There were insufficient studies to meta-analyse sepsis and RTI-related mortality.ConclusionsOur results suggest that 25(OH)D deficiency in acute and critically ill children is high and associated with increased mortality. Small-study effects, reverse causation and other biases may have confounded results. Larger, carefully designed studies in homogeneous populations with confounder adjustment are needed to clarify the association between 25(OH)D levels with mortality and other outcomes.Prospero registration numberCRD42016050638.

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