Colistin, an Old Drug in a New Territory, Solid Organ Transplantation.

BACKGROUND: The clinical experience with colistin therapy for multidrug-resistant Gram-negative pathogens in solid organ transplantation is limited. METHODS: Patients transplanted from January 2003 to July 2011 and treated with intravenous or nebulized colistin were included. Descriptive statistics were used to summarize patients' characteristics and Kaplan-Meier curves for survival analysis. RESULTS: Fifteen patients were included: 10 adults (median age, 54.6 y; range, 32.2-79.6 y) and 5 children (median age, 3.3 y; range, 1.1-10.4 y). Eight patients had intra-abdominal infections, 3 had pneumonia, and 4 had bacteremia. The infections were diagnosed at a median of 5.9 months (range, 0.8-49.8 mo) after transplantation. Eight patients had coinfections, mainly with enteric pathogens. Pseudomonas aeruginosa was isolated in 13 cases and ESBL Klebsiella oxytoca and ESBL Escherichia coli were isolated in 1 case each. Thirteen patients received concomitant antibiotics with colistin. The median dose of intravenous colistin (13 patients) was 2.7 mg/kg/d (range, 1-4.9 mg/kg/d) and nebulized colistin (2 patients) was 241.7 mg/d (range, 150-333.3 mg/d). Clinical cure was achieved in 9 patients (60%). Four-week survival rate after infection was 86.7% (95% confidence interval, 56.4%-96.5%). There was no difference in the median creatinine clearance in adults (P = .38) or children (P = .88) before and after colistin. One patient had both neurotoxicity and nephrotoxicity, and 1 patient had neurotoxicity only. CONCLUSIONS: Colistin might be used as an alternate therapy for transplant patients with multidrug-resistant Gram-negative pathogens.

Clostridium difficile and cytomegalovirus colitis co-infection: search for the hidden 'bug'.

Few cases of co-infection with cytomegalovirus (CMV) and Clostridium difficile colitis have been reported previously. We describe 2 cases of CMV and C. difficile colitis, and review 7 previously published reports. We aim to raise awareness of possible CMV-C. difficile co-infection, especially in refractory cases of C. difficile colitis.

Enterococcus pneumonia complicated with empyema and lung abscess in an HIV-positive patient. Case report and review of the literature.

This report describes the first case of vancomycin-resistant Enterococcus pneumonia complicated with empyema and lung abscess in an HIV patient and reviews previously published cases of Enterococcus pleuro-pulmonary infection. Our case highlights the rarity of this entity and reviews the risk factors for Enterococcus pleuro-pulmonary infections.

[Details concerning a surgical technic in a case of esophagotracheal fistula]. / Particularitati de tehnica chirurgicala intr-un caz de fistula esotraheala

The authors present a surgical technique for the treatment of oeso-tracheal fistula located in the left supra-hylar fossa, by mobilization of the aorta and ligature of the first intercostal arteries, which provide sufficient light for the surgical procedures. The technique described is illustrated by a personal observation demonstrating its value by the simplicity of the post-operative evolution and the complete recovery. Stressing the difficulty encountered in the pre- and intraoperative localization of the fistula, the authors consider that the technique proposed by them is the type of the necessity technique, the only one allowing to perform a direct surgical approach of the fistula at this level.