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.
authors.affiliation: Infectious Diseases Division, University of Nebraska Medical Center, Omaha, Nebraska; Transplant Surgery Division, University of Nebraska Medical Center, Omaha, Nebraska. Electronic address: dflorescu@unmc.edu.
authors.forename: D F
authors.initials: DF
authors.lastname: Florescu
authors.affiliation: Infectious Diseases Division, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: C
authors.initials: C
authors.lastname: Mindru
authors.affiliation: Department of Pharmaceutical and Nutrition Care, Nebraska Medical Center, Omaha, Nebraska.
authors.forename: M A
authors.initials: MA
authors.lastname: Keck
authors.affiliation: Biostatistics Department, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: F
authors.initials: F
authors.lastname: Qiu
authors.affiliation: Infectious Diseases Division, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: A C
authors.initials: AC
authors.lastname: Kalil
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003091:Colistin / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D003091:Colistin