Colistin Sulfate for Decontamination of Preservation Fluid to Decrease Donor-derived Infections Caused by Multi-drug Resistant Gram-negative Pathogens

Abstract Background: Preservation fluid (PF) contamination, especially contamination with multi-drug resistant (MDR) Gram-negative pathogens, poses a high risk of donor-derived infections (DDIs) and severe clinical outcomes. We sought to determine whether the use of colistin sulfate to decontaminate PF in kidney transplantation can decrease probable DDIs (p-DDIs) caused by MDR Gram-negative pathogens.Methods: In a retrospective study of 916 recipients who received deceased donation, 864 PF samples were collected and cultured, and microbiological contaminants were recorded with the recipients’ clinical data and outcomes. From March 2016 to May 2019, 624 samples were decontaminated with ceftizoxime; from June 2019 to March 2021, colistin sulfate was administered for PF decontamination in 240 samples. Between-group comparisons were performed to assess the ability of the two decontamination regimens to decrease p-DDIs, especially MDR Gram-negative pathogen-related infections.Results: The overall PF contamination rate was 53.36% (461/864), and 80 samples had MDR Gram-negative pathogen contamination. All p-DDIs occurred in the ceftizoxime group (p<0.001), and 67.65% of p-DDIs were MDR Gram-negative pathogen-related. In the ceftizoxime group, 23 of 61 cases of MDR Gram-negative pathogen contamination led to related p-DDIs, while none occurred in the colistin sulfate group (p=0.002). Among these 23 patients with p-DDIs, 5 died of severe infections, and 2 experienced graft loss.Conclusions: The goal of decontamination should be decreasing MDR Gram-negative pathogen-related p-DDIs, and colistin sulfate could be an effective and feasible option.