Use of polymyxins for carbapenem-resistant infections in children and adolescents.

Background: Polymyxins are still used in children in some regions due to limited availability of newer antibiotics. Objectives: To describe our experience in a cohort of children who received polymyxins for suspected or confirmed carbapenem-resistant bacterial infections (CRI), and explore potential factors associated with therapeutic success. Methods: Retrospective, observational study in children and adolescents <18 years who received IV polymyxin B or colistin therapy for suspected or culture-documented CRI and were admitted to a high complexity clinic in Cali, Colombia between 1 September 2016 and 22 June 2020. Patients' demographic, clinical and microbiological characteristics were collected and analysed; associations with therapeutic success were explored using univariate and multivariate models. Results: There were 40 episodes of polymyxin use (polymyxin B, n = 34; colistin, n = 6) in 34 patients with a median age of 10 years (IQR 7-15); 65% were male. There were 17 adverse events: 3 (17.6%) neurotoxic and 14 (82.4%) nephrotoxic. Therapeutic success was achieved in 28 episodes (70%), of which 32% (9/28) had adverse events. Therapeutic success decreased by 35% with each additional year of age (OR 0.65; 95% CI 0.49-0.80) and by 7% for every hour that elapsed between the onset of fever and the start of appropriate antibiotic therapy (OR 0.93; 95% CI 0.8-0.97) and increased with concomitant non-carbapenem treatment (OR 6.87; 95% CI 1.04-71.01) and the use of adequate empirical therapy (OR 121.36; 95% CI 2.90-1147.95). Conclusions: Several factors were associated with the therapeutic success of polymyxins, however, more than half of episodes had therapeutic failure or adverse events. Antibiotics with greater efficacy and safety are needed in regions with high rates of CRI.

Medición del volumen residual en las agujas espinales tras anestesia raquídea / Measurement of residual volume in spinal needles after spinal anesthesia

ABSTRACT Introduction: Spinal anesthesia involves the administration of a dose of local anesthesia into the intrathecal space of the lumbar spine, using spinal needles with varying characteristics and design. When completing the administration of spinal anesthesia, you may check the volume of fluid remaining inside the spinal needle. Objective: To measure and compare the volume of residual fluid following the administration of spinal anesthesia using three different brands of 27 gauge spinal needles. Methods: This is an observational analytical cross-section trial for which tree types of 27 gauge commercial needles were selected: BD Whitacre pencil point, Spinocan Quincke sharp point, and Disposable spinal needle. Following the administration of spinal anesthesia, the same operator, without detaching the syringe from the needle, deposited the residual vol ume into a collection tube so that a second operator quantifies the volume using a precision micropipette. Results: The residual volume obtained fromthe27Gspinalneedlesshowed astatistically significant difference in favor of the BD Whitacre needles (P < 0.01), compared against Spinocan Quincke and Disposable spinal needle. Conclusions: The BD Whitacre pencil point proved to lodge less residual volume following spinal anesthesia. No clinical implications can be made from this finding and new studies are required to ratify these results.

R E S U M E N Introducción: La anestesia raquídea consiste en la aplicación de una dosis de anestésico local en el espacio intratecal de la columna lumbar, por medio de agujas espinales cuyas características varían tanto en calibre como en diseño. Al terminar la aplicación de una anestesia raquídea se puede comprobar un volumen remanente de líquido en el interior de la aguja espinal. Objetivo: Medir y comparar el volumen remanente de líquido posterior a la aplicación de anestesia raquídea en 3 marcas comerciales de agujas espinales de calibre 27. Métodos: Este es un estudio observacional analítico de corte transversal; se escogieron 3 tipos comerciales de agujas de calibre 27: BD Whitacre punta de lápiz, Spinocan Quincke punta cortante y Disposable spinal needle. Tras la aplicación de una anestesia raquídea, el mismo operador, sin desconectar la jeringa de la aguja, depositó el volumen residual en un tubo de recolección, para que un segundo operador cuantificara el volumen con una micropipeta de precisión. Resultados: El volumen residual obtenido de las agujas espinales 27G mostró una diferencia estadísticamente significativa a favor de las agujas BD Whitacre (p<0,01), comparadas con las agujas Spinocan Quincke y Disposable spinal needle. Conclusiones: Se comprobó que las agujas BD Whitacre pencil point alojan un menor volumen residual después de una anestesia espinal. No se puede afirmar que este hallazgo tenga implicaciones clínicas. Son necesarios nuevos estudios para corroborar estos resultados.