Colistin (Polymyxin E) Use in Abdominal Solid Organ Transplant Recipients

Area of Science:

• Transplantation Medicine
• Infectious Diseases
• Pharmacology

Background:

• Solid organ transplant recipients face increased risk of multi-drug resistant (MDR) bacterial infections post-surgery.
• Colistin is often used to treat these challenging infections.

Purpose of the Study:

• To audit colistin usage, dosage appropriateness, and safety in abdominal solid organ transplant recipients.
• To assess colistin's role in treating immediate post-transplant bacterial infections.

Main Methods:

• Retrospective audit of 1170 abdominal solid organ transplant recipients (Oct 2010 - Dec 2019).
• Analysis of colistin use, microbiological data, minimum inhibitory concentrations (MICs), dosing appropriateness, and nephrotoxicity.
• Evaluation of outcomes in 82 patients who received colistin for MDR infections.

Main Results:

• Colistin was administered to 82 recipients (66 liver, 16 renal) for MDR infections.
• Colistin was used as definitive therapy in ~60% and combination therapy in 87.81%.
• High in-hospital mortality (43.9%) observed; renal impairment in 28.8% of liver transplant recipients.

Conclusions:

• Infections requiring colistin significantly increase mortality in liver (3-fold) and renal (5 percentage points) transplant recipients.
• This study underscores the critical need for judicious colistin use and vigilant monitoring in transplant patients.