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Published on: May 26, 2015
Colistin sulfate for decontamination of preservation fluid in kidney transplantation to decrease the incidence of
Mingxing Sui1, Nanxin Zheng2, Da Xu3
1Department of Organ Transplantation, Changhai Hospital, Shanghai, China.
Background:
Preservation fluid (PF) contamination, especially by multidrug-resistant (MDR) Gram-negative bacteria (GNB), poses a high risk of donor-derived infection (DDI) and severe clinical outcomes. We sought to determine whether the use of colistin sulfate to decontaminate PF in kidney transplantation can decrease the incidence of probable DDI (p-DDI) caused by MDR GNB.
Methods:
In a retrospective study of 916 recipients who received deceased donation, 864 PF samples were collected and cultured, and microbiological contaminants were recorded with the recipients' clinical data and outcomes. From March 2016 to May 2019, 624 samples were decontaminated with ceftizoxime, and from June 2019 to March 2021, 240 samples were decontaminated with colistin sulfate. Between-group comparisons were performed to assess the ability of the two decontamination regimens to decrease the incidence of p-DDI, especially MDR GNB-related infection.
Results:
The overall PF contamination rate was 54.51% (471/864), and 80 samples were positive for MDR GNB contamination. All p-DDIs occurred in the ceftizoxime group (p < 0.001), and 67.65% of p-DDIs were MDR GNB-related. In the ceftizoxime group, 23 of 61 cases of MDR GNB contamination led to related p-DDIs, while none occurred in the colistin sulfate group (p = 0.002). Among the 23 patients with p-DDIs, 5 died due to severe infection, and 2 experienced graft loss.
Conclusions:
The goal of decontamination should be to decrease the risk of MDR GNB-related p-DDI, and colistin sulfate could be an effective and feasible option.
Insights
Colistin sulfate effectively decontaminated kidney preservation fluid, significantly reducing multidrug-resistant Gram-negative bacteria contamination and preventing donor-derived infections in kidney transplantation. This offers a safer approach to organ preservation.
Area of Science:
- Nephrology
- Infectious Diseases
- Transplantation Immunology
Background:
- Preservation fluid (PF) contamination by multidrug-resistant Gram-negative bacteria (MDR GNB) risks donor-derived infections (DDIs) in kidney transplant recipients.
- MDR GNB contamination of PF can lead to severe clinical outcomes and graft loss.
Purpose of the Study:
- To evaluate the efficacy of colistin sulfate in decontaminating PF compared to ceftizoxime.
- To determine if colistin sulfate reduces the incidence of probable DDIs (p-DDIs) caused by MDR GNB in kidney transplantation.
Main Methods:
- Retrospective analysis of 916 kidney transplant recipients and 864 PF samples.
- Comparison of PF decontamination using ceftizoxime (March 2016-May 2019) versus colistin sulfate (June 2019-March 2021).
- Assessment of p-DDI incidence, particularly MDR GNB-related infections.
Main Results:
- Overall PF contamination rate was 54.51%, with 80 samples positive for MDR GNB.
- All p-DDIs (23 cases) occurred in the ceftizoxime group; 67.65% were MDR GNB-related.
- No p-DDIs occurred in the colistin sulfate group (p=0.002), preventing severe infections and graft loss.
Conclusions:
- Colistin sulfate is an effective and feasible option for PF decontamination.
- Reducing MDR GNB contamination in PF is crucial for preventing p-DDIs in kidney transplantation.
- Implementing colistin sulfate decontamination may improve transplant outcomes.
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