Efficacy and Safety of Colistin Sulfate in Treating Carbapenem-Resistant Gram-Negative Bacterial Infections in Liver Transplant Recipients.

OBJECTIVE

Carbapenem-resistant Gram-negative bacteria (CR-GNB), including carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Acinetobacter baumannii (CRAB), are critical postoperative complications in liver transplant recipients. This study aimed to evaluate the clinical efficacy and safety of intravenous colistin sulfate (CS) in treating CR-GNB infections in liver transplant patients and identify independent predictive factors influencing therapeutic outcomes.

METHODS

A retrospective cohort of 20 liver transplant recipients with CR-GNB infections admitted to the intensive care unit (ICU) was included. Patients received intravenous colistin sulfate and were stratified into an effective treatment group (n = 10) and an ineffective group (n = 10) based on clinical response. Baseline clinical data and laboratory parameters were collected. Chi-square tests and t-tests compared differences between groups. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify independent predictors of CS efficacy.

RESULTS

Significant differences in serum procalcitonin (PCT) and tumor necrosis factor-alpha (TNF-α) levels were observed between the effective and ineffective groups (P < .05). Multivariate analysis identified TNF-α (OR = 1.009, 95% CI: 0.955-1.066; P = .049) and PCT (OR = 0.590, 95% CI: 0.350-0.997; P = .049) as independent predictors of treatment efficacy. ROC curve analysis demonstrated that TNF-α alone predicted efficacy with an area under the curve (AUC) of 0.900 (specificity=100%, sensitivity=70%), while PCT showed an AUC of 0.885 (specificity = 100%, sensitivity = 80%). Combined TNF-α and PCT improved predictive accuracy (AUC = 0.970, specificity = 100%, sensitivity = 90%).

CONCLUSION

TNF-α and PCT serve as reliable biomarkers for optimizing colistin sulfate therapy in liver transplant recipients with CR-GNB infections. Dynamic monitoring of these inflammatory markers during treatment may enhance therapeutic outcomes.