AUTHOR=Grall Nathalie , Assadi Maksud , Esposito-Farese Marina , Lortat-Jacob Brice , Tanaka Sébastien , Atchade Enora , Messika Jonathan , Bunel Vincent , Mal Hervé , Mordant Pierre , Castier Yves , Garnier Bastien , Gueye Signara , Petitjean Marie , Denamur Erick , Armand-Lefevre Laurence , Burdet Charles , Montravers Philippe , Tran-Dinh Alexy TITLE=No Emergence of Colistin Resistance in the Respiratory Tract of Lung Transplant Patients Treated With Inhaled Colistin JOURNAL=Transplant International VOLUME=37 YEAR=2025 URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2024.13545 DOI=10.3389/ti.2024.13545 ISSN=1432-2277 ABSTRACT=

Secondary prophylaxis using inhaled colistin (IC) was implemented to prevent recurrences of Pseudomonas aeruginosa or extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) pneumonia during the postoperative intensive care unit (ICU) stay after lung transplantation (LT). We evaluated the risk of emergence of colistin resistance in the respiratory tract during secondary IC prophylaxis. We conducted a prospective, single-centre, observational study of all adult patients who underwent LT between 1 July 2018 and 30 June 2019. IC was started and continued for at least 90 days for P. aeruginosa or ESBL-PE pneumonia. During the 90 days following LT, all respiratory samples were routinely tested for the presence of GNB of reduced susceptibility to colistin. Twenty-seven (38.6%) of the 70 included patients received IC. Among the 867 respiratory samples tested, IC did not promote the emergence of bacterial species with natural or acquired resistance to colistin (incidence-rate ratio of 0.21 [0.03–1.58], p = 0.13 and 1.68 [0.55–5.12], p = 0.37, respectively). Our study suggests no association between the use of IC and an increased risk of colistin resistance in the respiratory tract within 90 days of LT.