Treatment of multidrug-resistant gram-negative bacilli after solid organ transplant: Outcomes and complications

Area of Science:

• Infectious Diseases
• Transplant Medicine
• Pharmacology

Background:

• Multidrug-resistant gram-negative bacilli (GNB) infections pose a serious threat to solid organ transplant (SOT) recipients, leading to high rates of morbidity and mortality.
• Understanding the impact of antibiotic treatments on outcomes in SOT recipients with GNB infections is crucial for optimizing patient care.

Purpose of the Study:

• To evaluate the effects of specific antibiotic classes on nephrotoxicity, neurotoxicity, 30-day mortality, and length of hospital and intensive care unit (ICU) stay.
• To identify effective treatments for multidrug-resistant GNB infections in SOT recipients.

Main Methods:

• Retrospective data collection from SOT recipients treated for multidrug-resistant GNB infections between January 2007 and April 2017.
• Analysis of antibiotic exposure, including carbapenems, polymyxins, and aminoglycosides, in relation to clinical outcomes.

Main Results:

• Carbapenem-sensitive GNB infections were associated with decreased 30-day mortality (OR 0.35).
• Polymyxin use increased the odds of neurotoxicity (8% per day of exposure). Aminoglycoside exposure correlated with increased hospital length-of-stay.
• Carbapenem exposure was linked to reduced 30-day mortality (OR 0.93). No significant impact on 30-day mortality was observed for other antibiotic classes.

Conclusions:

• Carbapenems are a safe and effective treatment option for SOT recipients with carbapenem-sensitive multidrug-resistant GNB infections.
• Managing infections caused by carbapenem-resistant gram-negative bacilli in SOT recipients continues to be a significant clinical challenge.