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Published on: November 6, 2012
Multidrug-resistant Enterobacterales infections in abdominal solid organ transplantation
Benoît Pilmis1, Emmanuel Weiss2, Anne Scemla3
1Centre d'infectiologie Necker-Pasteur, Hôpital Necker Enfants-Malades, Centre médical de l'institut Pasteur, Université de Paris, Paris, France; Équipe mobile de microbiologie Clinique, Groupe Hospitalier Paris Saint Joseph, Paris, France; Institut Micalis, UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, Chatenay-Malabry, France.
Background:
Transplant recipients are highly susceptible to multidrug-resistant (MDR) related infections. The lack of early appropriate antimicrobial treatment may contribute to the high mortality due to MDR-related infections in transplant recipients especially in case of metallo-β-lactamases.
Objectives:
In this review, we present the current state of knowledge concerning multidrug-resistant Gram negative bacilli's risk management in the care of solid-organ transplant recipients and suggest control strategies.
Sources:
We searched for studies treating MDR g-negative bacilli related infections in the renal and hepatic transplant patient population. We included randomized and observational studies.
Content:
Solid-organ transplant is the best therapeutic option for patients diagnosed with end-stage organ disease. While the incidence of opportunistic infections is decreasing due to better prevention, the burden of "classical" infections related to MDR bacteria especially related to Gram-negative bacteria is constantly increasing. Over the last two decades, various MDR pathogens have emerged as a relevant cause of infection in this specific population associated with significant mortality. Several factors related to the management of transplant donor candidates and recipients increase the risk of MDR infections in transplant recipients. The awareness of this high susceptibility of transplant recipients to MDR-related infections challenges the choice of empirical therapy, while its appropriateness can only be validated a posteriori. Indeed, the lack of early appropriate antimicrobial treatment may contribute to the high mortality due to MDR-related infections in transplant recipients especially in case of metallo-β-lactamases.
Implications:
Multidrug-resistant Gram-negative bacteria are associated with high morbidity and mortality in solid organ transplant recipients. It seems important to identify patients at risk of colonization/MDR bacteria to evaluate strategies to limit the risk of secondary infections and to minimize the inappropriate use of broad-spectrum antibiotics.
Insights
Transplant recipients face high risks from multidrug-resistant (MDR) Gram-negative infections. Early, appropriate antimicrobial treatment is crucial to reduce mortality, especially with metallo-β-lactamases.
Area of Science:
- Infectious Diseases
- Transplantation Medicine
- Microbiology
Background:
- Transplant recipients are highly susceptible to multidrug-resistant (MDR) infections, particularly Gram-negative bacteria.
- The incidence of MDR Gram-negative infections is increasing in this population, leading to significant mortality.
- Factors related to transplant management increase the risk of MDR infections, challenging empirical therapy choices.
Purpose of the Study:
- To review the current knowledge on managing multidrug-resistant Gram-negative bacilli in solid-organ transplant recipients.
- To suggest effective control strategies for MDR infections in this vulnerable patient group.
Main Methods:
- Literature search for studies on MDR Gram-negative bacilli infections in renal and hepatic transplant patients.
- Inclusion of randomized and observational studies relevant to the topic.
Main Results:
- Multidrug-resistant Gram-negative bacteria are a significant cause of morbidity and mortality in solid organ transplant recipients.
- Lack of early appropriate antimicrobial treatment contributes to high mortality rates, especially with metallo-β-lactamases.
Conclusions:
- Identifying at-risk patients for colonization/MDR bacteria is essential.
- Strategies to limit secondary infections and minimize broad-spectrum antibiotic overuse are important.
- Effective risk management and control strategies are needed to improve outcomes for transplant recipients.
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