Yesim Coskun, Demet Yalcin, Ipek Akman, Seyda Ignak

Yenidoğanlarda Kolistin Tedavisinin Etkililiği ve Nefrolojik Yan Etkileri

Amaç: Toksik yan etkileri nedeniyle kolistin, uzun yıllardır ilk seçenek bir tedavi olarak görülmemekte- dir. Son zamanlarda ise yenidoğanlarda çoklu ilaç dirençli (ÇİD) gram-negatif bakteri (GNB) enfeksi- yonlarına karşı son tedavi seçeneği olarak yeniden değerlendirilmektedir. Bu çalışmada da yenidoğan- larda kolistin kullanımının etkililiğini ve nefrolojik yan etkilerini inceleyerek literatüre katkıda bulunmak amaçlanmıştır. Gereç ve Yöntemler: Retrospektif çalışmamız Ocak 2015—Şubat 2019 döneminde üçüncü basamak bir üniversite hastanesinin yenidoğan yoğun bakım ünitesinde gerçekleştirildi ve kültürle kanıtlanmış hastane kaynaklı GNB enfeksiyonları nedeniyle intravenöz kolistin tedavisi gören 30 hastayı içerdi. Tedavinin 1., 3. ve 10. günlerinde ölçülen serum sodyum, potasyum, fosfor, kalsiyum ve magnezyum düzeyleri, üre, kreatinin, aspartat aminotransferaz, alanin aminotransferaz değerleri ve idrar çıkışları analiz edildi. Bulgular: Tüm hastalar en az 10 gün (ortalama 16,07±3,22 gün) kolistin tedavisi görmüştü ve tedavi dozu günde 5 mg/kg idi. Birinci ve 10. gün üre, kreatinin, kalsiyum, magnezyum ve idrar çıkış değerleri arasında istatistiksel olarak anlamlı fark olduğu görüldü (p˂0,05). Benzer biçimde, tedavinin 1. ve 10. gününde kaydedilmiş olan ölçümler karşılaştırıldığında magnezyum ve kalsiyum düzeylerinde anlamlı bir azalma (sırasıyla p=0,008, p=0,038), üre, kreatinin ve idrar çıkış değerlerinde ise anlamlı bir artış (sırasıyla p=0,027, p=0,022, p=0,001) gözlendi. Tartışma ve Sonuç: Kolistin yenidoğanlarda ÇİD-GNB kaynaklı enfeksiyonların tedavisinde etkili bir ajandır. Yenidoğanlarda kolistin tedavisi sırasında nefrotoksisite yakından izlenmelidir. Yenidoğanlarda kolistin tedavisinin etkililiği ve güvenliliği daha büyük örneklemli, daha ileri çalışmalarla araştırılmalıdır.

The Efficacy and Nephrological Side Effects of Treatment with Colistin in Neonates

Aim: For many years, colistin has not been considered a first-line treatment due to its toxic side ef- fects. However, its use has recently been reevaluated as a last resort in the treatment of neonatal infections caused by multidrug-resistant (MDR) gram-negative bacteria (GNB). Accordingly, in this study we aimed to contribute to the literature by investigating the efficacy and nephrological effects of colistin use in neonates. Materials and Methods: The retrospective study was conducted in the neonatal intensive care unit of a tertiary university hospital between January 2015 and February 2019 and included 30 patients who received intravenous treatment with colistin for culture-proven hospital-acquired GNB infections. We analyzed the serum sodium, potassium, phosphate, calcium and magnesium levels, urea, creatinine, aspartate aminotransferase and alanine aminotransferase values, and urine outputs measured on the 1st, 3rd, and 10th days of treatment. Results: All patients were treated with colistin for at least 10 days (mean 16.07±3.22 days) and the treatment dose was 5 mg/kg per day. We observed a statistically significant difference between the 1st- and 10th-day urea, creatinine, calcium, magnesium, and urine output values (p˂0.05). Similarly, when we compared the measurements recorded on the 1st and 10th days of treatment, we found that the magnesium and calcium levels were significantly decreased (p=0.008 and p=0.038, respectively) while the urea, creatinine, and urine output values were significantly increased (p=0.027, p=0.022, p=0.001, respectively). Discussion and Conclusion: Colistin is an effective agent in the treatment of MDR-GNB infections in neonates. Neonates should be closely monitored for nephrotoxicity during treatment with colistin. The efficacy and safety of neonatal treatment with colistin should be investigated with further, larger- sample studies.

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