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Author Spotlight: Investigating the Key Factors of Obliterative Bronchiolitis After Lung Transplantation
Published on: November 10, 2023
Antibiotic Therapy for Difficult-to-Treat Infections in Lung Transplant Recipients: A Practical Approach
Lorena van den Bogaart1, Oriol Manuel1
1Infectious Diseases Service and Transplantation Center, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland.
Abstract:
Lung transplant recipients are at higher risk to develop infectious diseases due to multi-drug resistant pathogens, which often chronically colonize the respiratory tract before transplantation. The emergence of these difficult-to-treat infections is a therapeutic challenge, and it may represent a contraindication to lung transplantation. New antibiotic options are currently available, but data on their efficacy and safety in the transplant population are limited, and clinical evidence for choosing the most appropriate antibiotic therapy is often lacking. In this review, we provide a summary of the best evidence available in terms of choice of antibiotic and duration of therapy for MDR/XDR P. aeruginosa, Burkholderia cepacia complex, Mycobacterium abscessus complex and Nocardia spp. infections in lung transplant candidates and recipients.
Insights
Lung transplant recipients face increased infection risks from multidrug-resistant pathogens. This review summarizes evidence on antibiotic choices and treatment durations for these challenging infections in transplant patients.
Area of Science:
- Infectious Diseases
- Pulmonology
- Transplantation Medicine
Background:
- Lung transplant recipients are susceptible to infections caused by multidrug-resistant (MDR) and extensively drug-resistant (XDR) pathogens.
- Chronic respiratory colonization with these pathogens poses a significant therapeutic challenge and potential contraindication for lung transplantation.
Purpose of the Study:
- To review the current evidence on optimal antibiotic therapy for MDR/XDR infections in lung transplant candidates and recipients.
- To guide the selection of appropriate antibiotics and treatment durations for specific challenging pathogens.
Main Methods:
- Systematic review of available clinical evidence.
- Focus on infections caused by *P. aeruginosa*, *Burkholderia cepacia* complex, *Mycobacterium abscessus* complex, and *Nocardia* spp.
Main Results:
- Limited data exist on the efficacy and safety of new antibiotic options in transplant populations.
- Evidence for choosing specific antibiotic regimens and durations is often lacking.
Conclusions:
- There is a critical need for more clinical evidence to guide antimicrobial stewardship in lung transplant recipients.
- Optimizing treatment for MDR/XDR infections is crucial for improving outcomes in this vulnerable patient group.
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