New drugs for difficult bugs: management of multidrug-resistant gram-negative infections in solid organ transplant...

Area of Science:

• Infectious Diseases
• Transplantation Medicine
• Pharmacology

Background:

• Multidrug-resistant Gram-negative bacteria (MDRGN) present a critical challenge to patient and allograft survival in solid organ transplant (SOT) recipients.
• The limited antimicrobial pipeline and lack of systematic evaluation of novel agents in SOT populations complicate infection management.

Purpose of the Study:

• To review current therapeutic options for MDRGN infections in SOT recipients.
• To summarize the role of recently approved antimicrobial agents in managing difficult-to-treat Gram-negative infections in this vulnerable patient group.

Main Methods:

• Literature review focusing on antimicrobial therapies for MDRGN infections.
• Analysis of novel agents including second-generation β-lactam/β-lactamase inhibitors, cefiderocol, plazomicin, and eravacycline.
• Emphasis on evidence and recommendations specific to the SOT population.

Main Results:

• Novel antimicrobials offer new hope but have specific niches requiring further study in SOT recipients.
• Therapeutic strategies are discussed for extended-spectrum β-lactamase-producing Enterobacterales, carbapenem-resistant Enterobacterales, and difficult-to-treat resistant *Pseudomonas aeruginosa*.
• Recently approved agents are highlighted for their potential in combating MDRGN infections.

Conclusions:

• Effective management of MDRGN infections in SOT recipients necessitates a thorough understanding of novel antimicrobial agents and their appropriate use.
• Continued research and systematic evaluation of these agents in the transplant population are crucial for optimizing patient and allograft outcomes.