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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\u00a0days for <jats:italic>P. aeruginosa<\/jats:italic> or ESBL-PE pneumonia. During the 90\u00a0days 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\u20131.58], <jats:italic>p<\/jats:italic> = 0.13 and 1.68 [0.55\u20135.12], <jats:italic>p<\/jats:italic> = 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\u00a0days of LT.<\/jats:p>","DOI":"10.3389\/ti.2024.13545","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T12:00:47Z","timestamp":1737633647000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["No Emergence of Colistin Resistance in the Respiratory Tract of Lung Transplant Patients Treated With Inhaled 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