Brazilian perspective: antimicrobial stewardship in solid organ transplant

Area of Science:

• Infectious Diseases
• Transplantation Medicine
• Antimicrobial Stewardship

Background:

• Solid organ transplant (SOT) recipients in Brazil face a high incidence of multidrug-resistant organism (MDRO) infections.
• Carbapenem-resistant Enterobacterales (CRE) and vancomycin-resistant Enterococcus (VRE) are the most prevalent MDROs in this population.

Purpose of the Study:

• To review antimicrobial use and resistance patterns in SOT patients in Brazil.
• To identify key barriers and facilitators for implementing antimicrobial stewardship programs (ASPs) tailored for SOT recipients.

Main Methods:

• Literature review focusing on antimicrobial use, resistance, and ASPs in Brazilian SOT patients.
• Analysis of reported barriers hindering ASP implementation in healthcare settings.

Main Results:

• ASPs are mandatory in Brazil, yet specific data for SOT recipients is scarce.
• Major implementation barriers include a lack of electronic medical records, absence of SOT-specific national guidelines, limited rapid diagnostics, and insufficient dedicated personnel time for ASP activities.
• Donor-derived MDROs, including CREs, pose a significant challenge.

Conclusions:

• High rates of VRE and CRE infections persist in Brazilian SOT patients.
• A critical gap exists in data on antimicrobial use and the implementation of tailored ASPs for SOT recipients in Brazil.
• The lack of national ASP guidelines specific to SOT recipients is a primary obstacle to effective program implementation.