Background: Lung transplantation (LT) is a viable option for a select group of patients with end-stage lung disease. However, infections are a major complication after LT, accounting for significant morbidity and mortality. Several germs may be responsible; multidrug-resistant Gram-negative (MDR-GN) bacteria are emerging. Colistin is widely used in the treatment of these infections and is administered by inhalation and/or parenterally. At our institution, in patients with tracheostomy, colistin is administered by direct instillation in the airway during bronchoscopy. We reviewed a series of patients who underwent LT complicated by postoperative MDR-GN bacterial pulmonary infection. Methods: From January 2015 to May 2017, 26 lung transplants were performed. In the postoperative course, 14 (54%) developed MDR-GN bacterial infection; respiratory specimen culture, blood tests, and chest X-ray were considered. Colistin was the only antibiotic usable. Thirteen patients received intravenous (IV) colistin; in the subgroup of patients with tracheostomy, colistin was instilled directly in the airway, and 6 patients received inhaled colistin. Results: Seven patients needed tracheostomy. Pseudomonas aeruginosa was the predominant infection (86%), with Acinetobacter baumanii seen in 2 cases (14%). An early clinical-laboratory response was observed in 9 patients (64%). White blood cell count and C-reactive protein values improved (P =.02 and P =.001, respectively). A significant reduction in bacterial load was observed on microbiologic bronchoalveolar lavage specimens. Conclusion: Colistin instilled directly in the airway did not show side effects. The combination of IV and inhaled/instilled colistin could be a useful treatment option for MDR-GN infections after LT.

Colistin-based treatment of multidrug-resistant gram-negative bacterial pulmonary infections after lung transplantation / Carillo, C.; Pecoraro, Y.; Anile, M.; Poggi, C.; Oliva, A.; Amore, D.; Bruschini, P.; Naldi, G.; Mantovani, S.; Francioni, F.; Pugliese, F.; De Giacomo, T.; Venuta, F.; Diso, D.. - In: TRANSPLANTATION PROCEEDINGS. - ISSN 0041-1345. - 51:1(2019), pp. 202-205. [10.1016/j.transproceed.2018.04.068]

Colistin-based treatment of multidrug-resistant gram-negative bacterial pulmonary infections after lung transplantation

Carillo, C.
;
Pecoraro, Y.;Anile, M.;Poggi, C.;Oliva, A.;Amore, D.;Bruschini, P.;Naldi, G.;Mantovani, S.;Francioni, F.;Pugliese, F.;De Giacomo, T.;Venuta, F.;Diso, D.
2019

Abstract

Background: Lung transplantation (LT) is a viable option for a select group of patients with end-stage lung disease. However, infections are a major complication after LT, accounting for significant morbidity and mortality. Several germs may be responsible; multidrug-resistant Gram-negative (MDR-GN) bacteria are emerging. Colistin is widely used in the treatment of these infections and is administered by inhalation and/or parenterally. At our institution, in patients with tracheostomy, colistin is administered by direct instillation in the airway during bronchoscopy. We reviewed a series of patients who underwent LT complicated by postoperative MDR-GN bacterial pulmonary infection. Methods: From January 2015 to May 2017, 26 lung transplants were performed. In the postoperative course, 14 (54%) developed MDR-GN bacterial infection; respiratory specimen culture, blood tests, and chest X-ray were considered. Colistin was the only antibiotic usable. Thirteen patients received intravenous (IV) colistin; in the subgroup of patients with tracheostomy, colistin was instilled directly in the airway, and 6 patients received inhaled colistin. Results: Seven patients needed tracheostomy. Pseudomonas aeruginosa was the predominant infection (86%), with Acinetobacter baumanii seen in 2 cases (14%). An early clinical-laboratory response was observed in 9 patients (64%). White blood cell count and C-reactive protein values improved (P =.02 and P =.001, respectively). A significant reduction in bacterial load was observed on microbiologic bronchoalveolar lavage specimens. Conclusion: Colistin instilled directly in the airway did not show side effects. The combination of IV and inhaled/instilled colistin could be a useful treatment option for MDR-GN infections after LT.
2019
Surgery; infection; transplantation
01 Pubblicazione su rivista::01a Articolo in rivista
Colistin-based treatment of multidrug-resistant gram-negative bacterial pulmonary infections after lung transplantation / Carillo, C.; Pecoraro, Y.; Anile, M.; Poggi, C.; Oliva, A.; Amore, D.; Bruschini, P.; Naldi, G.; Mantovani, S.; Francioni, F.; Pugliese, F.; De Giacomo, T.; Venuta, F.; Diso, D.. - In: TRANSPLANTATION PROCEEDINGS. - ISSN 0041-1345. - 51:1(2019), pp. 202-205. [10.1016/j.transproceed.2018.04.068]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1248951
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