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Preheating colistimethate sodium enhances its efficacy against multi/extensively drug-resistant Gram-negative bacilli

Daqian Tang1,2, Lijie Zhang1, Yazhe Duan1

  • 1Department of Organ Transplantation, Shanghai Changhai Hospital, The First Affiliated Hospital of Naval Medical University, Shanghai, China.

Scientific Reports
|February 5, 2026
PubMed

Insights

Preheating colistimethate sodium (CMS) to 60°C effectively reduces multidrug-resistant Gram-negative bacilli in preservation fluid during cold storage. This thermal pretreatment offers a safe and practical method for decontamination, enhancing organ preservation.

Area of Science:

  • Microbiology
  • Pharmacology
  • Biotechnology

Background:

  • Multidrug-resistant and extensively drug-resistant (MDR/XDR) Gram-negative bacilli pose a significant threat in healthcare settings.
  • Preservation fluids (PF) used in organ transplantation can become contaminated with these resistant bacteria during static cold storage (SCS).
  • Effective decontamination strategies are crucial to prevent infectious complications associated with contaminated organs.

Purpose of the Study:

  • To evaluate the efficacy of preheated colistimethate sodium (CMS) in reducing MDR/XDR Gram-negative bacilli loads in PF under simulated SCS conditions.
  • To assess the preliminary safety of preheated CMS, specifically its nephrotoxicity, under hypothermic conditions.
  • To determine optimal preheating parameters (temperature and duration) for CMS activity.

Main Methods:

  • CMS was preheated at temperatures ranging from 37°C to 60°C for 5 to 30 minutes.
  • Antibacterial effects were tested against carbapenem-resistant Pseudomonas aeruginosa (CRPA), Klebsiella pneumoniae (CRKP), Escherichia coli (CREC), Acinetobacter baumannii (CRAB), and methicillin-resistant Staphylococcus aureus (MRSA).
  • Bacterial counts were assessed after 3 hours of SCS, and average inhibition rates (AIR) were calculated. Nephrotoxicity was evaluated using HK-2 cells.

Main Results:

  • Preheating CMS at 60°C for 15-30 minutes achieved significant bacterial load reduction, with AIRs up to 100% for CRPA, 96.91% for CRKP, 98.36% for CREC, and 85.06% for CRAB.
  • Lower temperatures (37°C) required longer heating times for partial efficacy, and CREC remained largely unaffected.
  • MRSA showed no susceptibility to preheated CMS. Preheated CMS exhibited no significant nephrotoxicity to HK-2 cells within 3-6 hours of SCS.

Conclusions:

  • Thermal pretreatment of CMS at 60°C is a novel, practical, and safe strategy for PF decontamination.
  • This method provides rapid bactericidal activity against common MDR/XDR Gram-negative bacilli encountered during SCS.
  • Preheated CMS shows potential for improving the safety of organ preservation by reducing bacterial contamination.
Keywords:
Colistimethate sodiumDecontaminationExtensively drug-resistantGram-negative bacteriaMultidrug resistantOrgan transplantationPreservation fluidStatic cold storage

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