Department of Pharmacy Practice, Amrita School of Pharmacy, Cochin, India.
Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences, Cochin, India.
J Pharm Pract. 2023 Aug;36(4):761-768. doi: 10.1177/08971900221074967. Epub 2022 Feb 24.
Patients undergoing solid organ transplantation are at a higher risk of multi-drug resistant (MDR) bacterial infections especially during the immediate post operative period. To audit the usage, dosage appropriateness and safety of colistin use in abdominal solid organ transplant recipients to treat immediate post-transplant bacterial infections. After completion of 1000 abdominal solid organ transplants at our institute, data of the transplant recipients who received colistin between October 2010 and December 2019 was extracted from the hospital health information system. Data of all microbiological culture isolates, the minimum inhibitory concentration (MIC) of colistin, appropriateness of colistin dosing and nephrotoxicity associated with colistin use was assessed. Of the 1170 (732 liver and 438 renal) solid organ transplant recipients, 82 (66 liver and 16 renal) received colistin to treat posttransplant MDR bacterial infections. Nearly 60% received colistin as definitive therapy and 87.81% received colistin as combination. Mean duration of colistin therapy was found to be higher in renal than liver transplant recipients. Out of the total 89 bacterial isolates, there were 2 colistin resistant Klebsiella strains. Colistin in combination with meropenem (36.4%) was the most commonly used dual therapy. Out of the total 89 bacterial isolates, there were 2 colistin resistant Klebsiella strains. Overall in-hospital mortality of patients who received colistin was 43.9%. Renal impairment occurred in 28.8% of liver transplant recipients. Infection necessitating colistin use increases mortality by three folds in liver transplant recipients and by five percentage points in renal transplant recipients.
在实体器官移植患者中，尤其是在术后早期，他们面临着更高的多重耐药（MDR）细菌感染风险。本研究旨在审查我院腹腔脏器移植患者中使用黏菌素治疗术后即刻细菌感染的使用情况、剂量适宜性和安全性。在我院完成 1000 例腹腔脏器移植后，从医院健康信息系统中提取了 2010 年 10 月至 2019 年 12 月期间接受黏菌素治疗的移植受者的数据。评估了所有微生物培养分离株、黏菌素的最小抑菌浓度（MIC）、黏菌素剂量的适宜性以及与黏菌素使用相关的肾毒性。在 1170 例（732 例肝移植和 438 例肾移植）实体器官移植受者中，82 例（66 例肝移植和 16 例肾移植）接受黏菌素治疗术后 MDR 细菌感染。近 60%的患者接受黏菌素作为确定性治疗，87.81%的患者接受黏菌素联合治疗。肾移植受者黏菌素治疗的平均持续时间长于肝移植受者。在总共 89 株细菌分离株中，有 2 株耐黏菌素的肺炎克雷伯菌。黏菌素联合美罗培南（36.4%）是最常用的双联治疗。在总共 89 株细菌分离株中，有 2 株耐黏菌素的肺炎克雷伯菌。接受黏菌素治疗的患者总院内死亡率为 43.9%。肝移植受者中有 28.8%发生了肾功能损害。在肝移植受者中，需要使用黏菌素感染会使死亡率增加两倍，在肾移植受者中增加 5 个百分点。
