Antimicrobial prophylaxis regimens following transplantation

Area of Science:

• Transplantation Medicine
• Infectious Diseases
• Immunology

Background:

• Infection is a significant cause of morbidity and mortality post-transplant.
• Antimicrobial prophylaxis strategies are continuously being refined.
• This review focuses on recent advancements in infection prevention for solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients.

Purpose of the Study:

• To summarize key studies on antimicrobial prophylaxis in SOT and HSCT published within the last 18 months.
• To highlight recent findings and evolving guidelines in transplant infectious disease prevention.

Main Methods:

• Review of recent (last 18 months) published studies on antimicrobial prophylaxis in SOT and HSCT.
• Synthesis of findings from randomized trials and international consensus guidelines.

Main Results:

• Extended antiviral prophylaxis (100-200 days or 12 months) demonstrates advantages for cytomegalovirus (CMV) prevention in high-risk SOT.
• Newer approaches for hepatitis B virus (HBV) prevention are under evaluation, potentially reducing or eliminating the need for hepatitis B immunoglobulin.
• International guidelines for HSCT infection prevention are summarized, alongside new research on invasive fungal infection prevention.

Conclusions:

• Antimicrobial prophylaxis regimens (antibacterial, antiviral, antifungal) must be individualized based on donor transmission risks, recipient serology, and drug levels.
• Extended CMV prophylaxis may benefit high-risk SOT patients.
• HSCT prophylaxis requires tailoring to transplant type and graft-versus-host disease risk.