Solid organ transplant patients: are there opportunities for antimicrobial stewardship?

Area of Science:

• Medical Sciences
• Infectious Diseases
• Pharmacology

Background:

• Rising incidence of Clostridium difficile and multidrug-resistant organisms infections necessitates enhanced antimicrobial stewardship.
• A declining pipeline of new antimicrobials underscores the importance of optimizing existing treatments, particularly in vulnerable populations like organ transplant recipients.

Purpose of the Study:

• To evaluate antimicrobial prescribing practices in organ transplant recipients.
• To identify opportunities for interdisciplinary collaboration between transplant, antimicrobial stewardship, and infectious diseases teams to improve antimicrobial use.

Main Methods:

• Conducted real-time audits of antimicrobial therapy in transplant patients, assessing regimens against Centers for Disease Control and Prevention stewardship principles and transplant-specific guidelines.
• Utilized Chi-square test to compare stewardship-concordant and discordant prescriptions based on infectious diseases consultation.

Main Results:

• Of 176 audits, 58% of patients received antimicrobials, with 69.9% of these being stewardship-concordant.
• Infections were present in 52.3% of patients; 98.9% received antimicrobials, but only 41.8% were prescribed by transplant clinicians.
• Infectious diseases consultation was linked to significantly higher stewardship-concordant prescriptions (78.5% vs. 59.6%, p=0.03). Common discrepancies included lack of de-escalation, overly broad empiric spectrum, and prolonged therapy duration.

Conclusions:

• Significant opportunities exist to enhance antimicrobial stewardship in organ transplant recipients.
• Interdisciplinary collaboration, particularly involving infectious diseases consultation, is crucial for optimizing antimicrobial prescribing and improving patient outcomes.