Colistin, an old drug in a new territory, solid organ transplantation

Diana F Florescu, C. Mindru, M. A. Keck, F. Qiu, Andre C Kalil

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background The clinical experience with colistin therapy for multidrug-resistant Gram-negative pathogens in solid organ transplantation is limited. Methods Patients transplanted from January 2003 to July 2011 and treated with intravenous or nebulized colistin were included. Descriptive statistics were used to summarize patients' characteristics and Kaplan-Meier curves for survival analysis. Results Fifteen patients were included: 10 adults (median age, 54.6 y; range, 32.2-79.6 y) and 5 children (median age, 3.3 y; range, 1.1-10.4 y). Eight patients had intra-abdominal infections, 3 had pneumonia, and 4 had bacteremia. The infections were diagnosed at a median of 5.9 months (range, 0.8-49.8 mo) after transplantation. Eight patients had coinfections, mainly with enteric pathogens. Pseudomonas aeruginosa was isolated in 13 cases and ESBL Klebsiella oxytoca and ESBL Escherichia coli were isolated in 1 case each. Thirteen patients received concomitant antibiotics with colistin. The median dose of intravenous colistin (13 patients) was 2.7 mg/kg/d (range, 1-4.9 mg/kg/d) and nebulized colistin (2 patients) was 241.7 mg/d (range, 150-333.3 mg/d). Clinical cure was achieved in 9 patients (60%). Four-week survival rate after infection was 86.7% (95% confidence interval, 56.4%-96.5%). There was no difference in the median creatinine clearance in adults (P =.38) or children (P =.88) before and after colistin. One patient had both neurotoxicity and nephrotoxicity, and 1 patient had neurotoxicity only. Conclusions Colistin might be used as an alternate therapy for transplant patients with multidrug-resistant Gram-negative pathogens.

Original languageEnglish (US)
Pages (from-to)152-157
Number of pages6
JournalTransplantation Proceedings
Volume48
Issue number1
DOIs
StatePublished - Jan 1 2016

Fingerprint

Colistin
Hong Kong
Organ Transplantation
Pharmaceutical Preparations
Klebsiella oxytoca
Intraabdominal Infections
Survival Analysis
Bacteremia
Infection
Coinfection
Pseudomonas aeruginosa
Creatinine
Pneumonia

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Colistin, an old drug in a new territory, solid organ transplantation. / Florescu, Diana F; Mindru, C.; Keck, M. A.; Qiu, F.; Kalil, Andre C.

In: Transplantation Proceedings, Vol. 48, No. 1, 01.01.2016, p. 152-157.

Research output: Contribution to journalArticle

@article{bdfbb819e3434e0382c1426c0ba4e992,
title = "Colistin, an old drug in a new territory, solid organ transplantation",
abstract = "Background The clinical experience with colistin therapy for multidrug-resistant Gram-negative pathogens in solid organ transplantation is limited. Methods Patients transplanted from January 2003 to July 2011 and treated with intravenous or nebulized colistin were included. Descriptive statistics were used to summarize patients' characteristics and Kaplan-Meier curves for survival analysis. Results Fifteen patients were included: 10 adults (median age, 54.6 y; range, 32.2-79.6 y) and 5 children (median age, 3.3 y; range, 1.1-10.4 y). Eight patients had intra-abdominal infections, 3 had pneumonia, and 4 had bacteremia. The infections were diagnosed at a median of 5.9 months (range, 0.8-49.8 mo) after transplantation. Eight patients had coinfections, mainly with enteric pathogens. Pseudomonas aeruginosa was isolated in 13 cases and ESBL Klebsiella oxytoca and ESBL Escherichia coli were isolated in 1 case each. Thirteen patients received concomitant antibiotics with colistin. The median dose of intravenous colistin (13 patients) was 2.7 mg/kg/d (range, 1-4.9 mg/kg/d) and nebulized colistin (2 patients) was 241.7 mg/d (range, 150-333.3 mg/d). Clinical cure was achieved in 9 patients (60{\%}). Four-week survival rate after infection was 86.7{\%} (95{\%} confidence interval, 56.4{\%}-96.5{\%}). There was no difference in the median creatinine clearance in adults (P =.38) or children (P =.88) before and after colistin. One patient had both neurotoxicity and nephrotoxicity, and 1 patient had neurotoxicity only. Conclusions Colistin might be used as an alternate therapy for transplant patients with multidrug-resistant Gram-negative pathogens.",
author = "Florescu, {Diana F} and C. Mindru and Keck, {M. A.} and F. Qiu and Kalil, {Andre C}",
year = "2016",
month = "1",
day = "1",
doi = "10.1016/j.transproceed.2016.01.011",
language = "English (US)",
volume = "48",
pages = "152--157",
journal = "Transplantation Proceedings",
issn = "0041-1345",
publisher = "Elsevier USA",
number = "1",

}

TY - JOUR

T1 - Colistin, an old drug in a new territory, solid organ transplantation

AU - Florescu, Diana F

AU - Mindru, C.

AU - Keck, M. A.

AU - Qiu, F.

AU - Kalil, Andre C

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background The clinical experience with colistin therapy for multidrug-resistant Gram-negative pathogens in solid organ transplantation is limited. Methods Patients transplanted from January 2003 to July 2011 and treated with intravenous or nebulized colistin were included. Descriptive statistics were used to summarize patients' characteristics and Kaplan-Meier curves for survival analysis. Results Fifteen patients were included: 10 adults (median age, 54.6 y; range, 32.2-79.6 y) and 5 children (median age, 3.3 y; range, 1.1-10.4 y). Eight patients had intra-abdominal infections, 3 had pneumonia, and 4 had bacteremia. The infections were diagnosed at a median of 5.9 months (range, 0.8-49.8 mo) after transplantation. Eight patients had coinfections, mainly with enteric pathogens. Pseudomonas aeruginosa was isolated in 13 cases and ESBL Klebsiella oxytoca and ESBL Escherichia coli were isolated in 1 case each. Thirteen patients received concomitant antibiotics with colistin. The median dose of intravenous colistin (13 patients) was 2.7 mg/kg/d (range, 1-4.9 mg/kg/d) and nebulized colistin (2 patients) was 241.7 mg/d (range, 150-333.3 mg/d). Clinical cure was achieved in 9 patients (60%). Four-week survival rate after infection was 86.7% (95% confidence interval, 56.4%-96.5%). There was no difference in the median creatinine clearance in adults (P =.38) or children (P =.88) before and after colistin. One patient had both neurotoxicity and nephrotoxicity, and 1 patient had neurotoxicity only. Conclusions Colistin might be used as an alternate therapy for transplant patients with multidrug-resistant Gram-negative pathogens.

AB - Background The clinical experience with colistin therapy for multidrug-resistant Gram-negative pathogens in solid organ transplantation is limited. Methods Patients transplanted from January 2003 to July 2011 and treated with intravenous or nebulized colistin were included. Descriptive statistics were used to summarize patients' characteristics and Kaplan-Meier curves for survival analysis. Results Fifteen patients were included: 10 adults (median age, 54.6 y; range, 32.2-79.6 y) and 5 children (median age, 3.3 y; range, 1.1-10.4 y). Eight patients had intra-abdominal infections, 3 had pneumonia, and 4 had bacteremia. The infections were diagnosed at a median of 5.9 months (range, 0.8-49.8 mo) after transplantation. Eight patients had coinfections, mainly with enteric pathogens. Pseudomonas aeruginosa was isolated in 13 cases and ESBL Klebsiella oxytoca and ESBL Escherichia coli were isolated in 1 case each. Thirteen patients received concomitant antibiotics with colistin. The median dose of intravenous colistin (13 patients) was 2.7 mg/kg/d (range, 1-4.9 mg/kg/d) and nebulized colistin (2 patients) was 241.7 mg/d (range, 150-333.3 mg/d). Clinical cure was achieved in 9 patients (60%). Four-week survival rate after infection was 86.7% (95% confidence interval, 56.4%-96.5%). There was no difference in the median creatinine clearance in adults (P =.38) or children (P =.88) before and after colistin. One patient had both neurotoxicity and nephrotoxicity, and 1 patient had neurotoxicity only. Conclusions Colistin might be used as an alternate therapy for transplant patients with multidrug-resistant Gram-negative pathogens.

UR - http://www.scopus.com/inward/record.url?scp=84959100952&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84959100952&partnerID=8YFLogxK

U2 - 10.1016/j.transproceed.2016.01.011

DO - 10.1016/j.transproceed.2016.01.011

M3 - Article

C2 - 26915861

AN - SCOPUS:84959100952

VL - 48

SP - 152

EP - 157

JO - Transplantation Proceedings

JF - Transplantation Proceedings

SN - 0041-1345

IS - 1

ER -