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Challenges of Antimicrobial Resistance and Stewardship in Solid Organ Transplant Patients
Miranda So1,2, Laura Walti1
1Toronto General Hospital, University Health Network, 9th Floor Munk Building, Room 800, 585 University Avenue, Toronto, ON M5G 2N2 Canada.
Purpose Of Review:
Without effective antimicrobials, patients cannot undergo transplant surgery safely or sustain immunosuppressive therapy. This review examines the burden of antimicrobial resistance in solid organ transplant recipients and identifies opportunities for antimicrobial stewardship.
Recent Findings:
Antimicrobial resistance has been identified to be the leading cause of death globally. Multidrug-resistant pathogens are associated with significant morbidity and mortality in transplant recipients. Methicillin-resistant S. aureus affects liver and lung recipients, causing bacteremia, pneumonia, and surgical site infections. Vancomycin-resistant enterococci is a nosocomial pathogen primarily causing bacteremia in liver recipients. Multidrug-resistant Gram-negative pathogens present urgent and serious threats to transplant recipients. Extended-spectrum beta-lactamase-producing E. coli and K. pneumoniae commonly cause bacteremia and intra-abdominal infections in liver and kidney recipients. Carbapenemase-producing Enterobacterales, mainly K. pneumoniae, are responsible for infections early-post transplant in liver, lung, kidney, and heart recipients. P. aeruginosa and A. baumannii continue to be critical threats. While there are new antimicrobial agents targeting resistant pathogens, judicious prescribing is crucial to minimize emerging resistance. The full implications of the COVID-19 global pandemic on antimicrobial resistance in transplant recipients remain to be understood. Currently, there are no established standards on the implementation of antimicrobial stewardship interventions, but strategies that leverage existing antimicrobial stewardship program structure while tailoring to the needs of transplant recipients may help to optimize antimicrobial use.
Summary:
Clinicians caring for transplant recipients face unique challenges tackling emerging antimcirobial resistance. Coordinated antimicrobial stewardship interventions in collaboration with appropriate expertise in transplant and infectious diseases may mitigate against such threats.
Insights
Antimicrobial resistance poses a significant threat to organ transplant recipients, increasing morbidity and mortality. Effective antimicrobial stewardship programs are crucial to combat drug-resistant infections in these vulnerable patients.
Area of Science:
- Infectious Diseases
- Transplant Medicine
- Pharmacology
Background:
- Antimicrobial resistance (AMR) is a global health crisis, leading to increased mortality.
- Multidrug-resistant pathogens significantly impact transplant recipients, causing severe infections and higher mortality rates.
- Specific resistant organisms like MRSA, VRE, ESBL-producing Gram-negatives, and carbapenemase-producing Enterobacterales pose critical threats.
Purpose of the Study:
- To review the burden of antimicrobial resistance in solid organ transplant (SOT) recipients.
- To identify key challenges and opportunities for antimicrobial stewardship in this population.
- To inform strategies for optimizing antimicrobial use in transplant care.
Main Methods:
- Literature review of studies on antimicrobial resistance in solid organ transplant recipients.
- Analysis of the impact of multidrug-resistant pathogens on transplant outcomes.
- Examination of current antimicrobial stewardship practices and potential interventions.
Main Results:
- Transplant recipients are highly susceptible to infections caused by multidrug-resistant pathogens.
- Common resistant pathogens include MRSA, VRE, ESBL-producing E. coli and K. pneumoniae, CPE, P. aeruginosa, and A. baumannii.
- Existing antimicrobial stewardship programs require adaptation to meet the specific needs of transplant patients.
Conclusions:
- Antimicrobial resistance presents a major challenge to safe transplantation and immunosuppressive therapy.
- Coordinated antimicrobial stewardship interventions, involving transplant and infectious disease specialists, are essential.
- Tailored strategies leveraging existing stewardship structures can optimize antimicrobial use and mitigate resistance threats.
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