Colistin use ups mortality risk in solid organ transplant recipients

Mortality increases threefold when using colistin to treat infections in liver transplant recipients and by 5 percentage points in renal transplant recipients, a study has shown.

A total of 1,170 (732 liver and 438 renal) solid organ transplant recipients were included in this study, of whom 82 (66 liver and 16 renal) received colistin for the treatment of post-transplant multidrug-resistant (MDR) bacterial infections.

Sixty percent of patients were treated with colistin as definitive therapy, while 87.81 percent used colistin as combination treatment. The most common dual therapy was colistin combined with meropenem (36.4 percent).

Renal transplant recipients had a higher mean duration of colistin therapy than liver transplant recipients. Eighty-nine bacterial isolates were obtained, of which two were colistin-resistant Klebsiella strains. In-hospital mortality rate was 43.9 percent overall among patients treated with colistin. Additionally, 28.8 percent of liver transplant recipients experienced renal impairment.

In this study, the authors extracted data of the transplant recipients who received colistin between October 2010 and December 2019 from the hospital health information system following the completion of 1,000 abdominal solid organ transplantations. They then examined the data of all microbiological culture isolates, the minimum inhibitory concentration of colistin, appropriateness of colistin dosing, and nephrotoxicity associated with colistin use.

“Patients undergoing solid organ transplantation are at a higher risk of MDR bacterial infections especially during the immediate postoperative period,” the authors said.