Which Antibiotic Should We Use in Children Who Have had Hematopoietic Stem Cell Transplantation and Have Multi-Drug Resistant Gram-Negative Infections? Single-Center Experience and Literature Review Hematopoietik Kök Hücre Nakli Yapılmış ve Çoklu İlaç Dirençli Gram-Negatif Enfeksiyonları Olan Çocuklarda Hangi Antibiyotik Kullanmalıyız? Tek Merkez Deneyimi ve Literatür Taraması

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MALBORA B., Sarbay H., ECE D., TURAN D., YAMALIOĞLU Z. D., ATAY A. A.

Cocuk Enfeksiyon Dergisi, cilt.20, sa.1, ss.61-69, 2026 (ESCI, Scopus, TRDizin) identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 20 Sayı: 1
  • Basım Tarihi: 2026
  • Doi Numarası: 10.5578/ced.20260123
  • Dergi Adı: Cocuk Enfeksiyon Dergisi
  • Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, Central & Eastern European Academic Source (CEEAS), CINAHL, EMBASE, TR DİZİN (ULAKBİM)
  • Sayfa Sayıları: ss.61-69
  • Anahtar Kelimeler: ceftazidimavibactam, child, colistin, hematopoietic stem cell transplantation, Multi drug-resistant gram-negative bacteria
  • İstanbul Yeni Yüzyıl Üniversitesi Adresli: Evet

Özet

Multidrug resistant gram-negative bacteria infections are major problem especially in immunocompromised patients who have received hematopoietic stem cell transplantation. In this study, we aimed to compare the effects of colistin-based and ceftazidim-avibactam based therapy in children with hematopoietic stem cell transplantation. The medical records of pediatric patients who received hematopoietic stem cell transplantation between February 2019 and May 2021 were assessed retrospectively. A pre-structured case report form was used to record demographics, underlying diseases, severity of illness upon admission, detailed description of index infection requiring ceftazidim-avibactam administration, data related to colistin, ceftazidim-avibactam, or other antibacterial administration, clinical and microbiologic responses, outcome, and adverse events. A total of 183 pediatric patients had hematopoietic stem cell transplantation between February 2019 and May 2021. Eighty-nine bacterial infections were detected, and seventy-two Gram-negative microorganisms were isolated in 57 of the patients. Fourteen (24.6%) of these patients had 18 (25%) multidrug resistant gram-negative microorganisms. Nephrotoxicity occurred in 5 of 7 (71%) of the patients who received colistin-based treatment, while hepatotoxicity occurred in 2 (28.5%) patients. Nephrotoxicity developed in 3 (42.8%) patients and hepatotoxicity in 2 (28.5%) patients in the ceftazidim-avibactam-based treatment group. Ten (71.4%) patients had clinical and microbiologic responses; however four patients died for various causes. In our study, we found that both colistin and ceftazidime-avibactam had similar survival rates in multidrug-resistant gram-negative infections in children who underwent hematopoietic stem cell transplantation. Organ toxicities observed in patients were mostly temporary. In addition, we observed that nephrotoxicity was less common in patients receiving ceftazidime-avibactam-based treatment. We think that colistin or ceftazidime-avibactam-based antibiotic combinations can be used successfully in pediatric patients with multidrug-resistant gram-negative infections.