Current state of antimicrobial stewardship and organ transplantation in Spain

Area of Science:

• Infectious Diseases
• Transplantation Medicine
• Antimicrobial Stewardship

Background:

• Solid-organ transplantation (SOT) recipients face high risks of nosocomial infections from multidrug-resistant (MDR) organisms and adverse antimicrobial events.
• These infections and adverse events significantly impact patient outcomes in SOT.
• Effective management strategies are needed to mitigate these risks.

Purpose of the Study:

• To evaluate the impact of an antimicrobial stewardship program (ASP) on solid-organ transplant (SOT) recipients.
• To review existing Spanish ASPs and their application in SOT.
• To highlight the need for data on ASP interventions in SOT populations.

Main Methods:

• Analysis of antimicrobial stewardship program (ASP) recommendations for SOT recipients at a university hospital from May 2017 to December 2021.
• Review of other Spanish ASP initiatives.
• Inclusion of data from a quasi-experimental study on joint ASP and hospital-acquired infection control (HAIC) initiatives in kidney transplant recipients.

Main Results:

• The ASP issued 2,785 recommendations, with 4.9% targeting SOT recipients.
• Recommendations led to treatment changes in over 78% of cases, with a 92% acceptance rate.
• A joint ASP and HAIC initiative significantly reduced the use of broad-spectrum antibiotics and the incidence of various infections in kidney transplant recipients.

Conclusions:

• Antimicrobial stewardship programs (ASP) integrated with hospital-acquired infection control (HAIC) are effective in improving outcomes for solid-organ transplant (SOT) patients.
• These combined programs should be implemented in all transplant centers.
• Further research and reporting from Spanish centers on ASP interventions in SOT are essential to understand efficacy and safety.