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Published on: August 30, 2018
Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients:
J M Aguado1, J T Silva2, M Fernández-Ruiz1
1Unit of Infectious Diseases, Instituto de Investigación Hospital "12 de Octubre" (i+12), University Hospital "12 de Octubre", Universidad Complutense, Madrid, Spain.
Abstract:
Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate's phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.
Insights
Solid organ transplant recipients face high risks from multidrug-resistant Gram-negative bacilli infections. Expert recommendations focus on carrier detection, hygiene, antibiotic stewardship, and tailored treatments for prevention and management.
Area of Science:
- Infectious Diseases
- Transplantation Medicine
- Antimicrobial Resistance
Background:
- Solid organ transplant (SOT) recipients are highly susceptible to multidrug-resistant Gram-negative bacilli (MDR GNB) infections due to frequent antibiotic exposure, healthcare settings, and invasive procedures.
- Existing guidelines for preventing and treating MDR GNB infections in SOT recipients are lacking.
Purpose of the Study:
- To provide expert recommendations for the prevention and treatment of MDR GNB infections in SOT recipients.
- To address the clinical challenges posed by MDR GNB colonization and infection in this vulnerable patient population.
Main Methods:
- A panel of experts reviewed existing evidence on MDR GNB in SOT recipients.
- Recommendations were formulated based on the synthesized evidence and expert consensus.
Main Results:
- Characterizing isolate resistance profiles (phenotypic and genotypic) is crucial.
- Donor colonization is generally not a contraindication for transplantation, but active graft infections should be avoided.
- Recipient colonization increases infection risk but is not a transplant contraindication.
- No specific surgical prophylaxis is recommended for carbapenem-resistant GNB carriers.
- Preventive measures include carrier detection, isolation, hand hygiene, and antibiotic stewardship.
- Intestinal decolonization lacks sufficient supporting data.
- Prophylactic inhaled antibiotics may benefit colonized lung transplant recipients, especially for Pseudomonas aeruginosa.
- Empirical treatment with active antibiotics is recommended for colonized SOT recipients, with therapy adjusted based on susceptibility and infection severity.
Conclusions:
- Expert consensus provides guidance on managing MDR GNB in SOT recipients.
- Key strategies involve early detection, appropriate precautions, antibiotic stewardship, and individualized treatment approaches.
- Further research is needed to support interventions like intestinal decolonization.
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