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Published on: February 9, 2011
Approach to multidrug resistant infections in pediatric transplant recipients
Sara W Dong1, Tanvi S Sharma2, Paul K Sue3
1Division of Infectious Diseases, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, United States.
Insights
Multidrug-resistant Gram-negative bacterial infections pose risks for pediatric transplant patients. Optimizing treatment and prevention strategies is crucial for improving patient and graft survival.
Area of Science:
- Pediatric Infectious Diseases
- Transplantation Medicine
- Antimicrobial Resistance
Background:
- Multidrug-resistant Gram-negative (MDRGN) bacterial infections are increasingly recognized in pediatric solid organ and hematopoietic cell transplant recipients.
- These infections are associated with significant morbidity and mortality in this vulnerable population.
Purpose of the Study:
- To present clinical challenges in evaluating, managing, and preventing MDRGN infections in pediatric transplant patients.
- To provide a framework for managing these complex infections.
Main Methods:
- Case vignettes illustrating clinical scenarios.
- Discussion of current and novel antimicrobial approaches.
- Review of preventative strategies including infection control and antimicrobial stewardship.
Main Results:
- Source control and appropriate antibiotic selection based on in vitro susceptibility are paramount.
- Identification of complex resistance mechanisms may require specialized testing.
- Treatment options include novel agents, prolonged infusions, and combination therapy.
Conclusions:
- Optimizing treatment and prevention strategies for MDRGN infections is essential.
- Effective management impacts patient and graft survival in pediatric transplant recipients.
Introduction:
There is increasing recognition of infections due to multidrug-resistant Gram negative (MDRGN) bacterial infections among children undergoing solid organ and hematopoietic cell transplantation, which may be associated with morbidity and mortality.
Methods:
We present two vignettes that highlight the clinical challenges of evaluation, management, and prevention of MDRGN bacterial infections in children prior to and after transplantation. The goal of this discussion is to provide a framework to help develop an approach to evaluation and management of these infections.
Results:
Source control remains the utmost priority in management of MDR infections and is paired with antibiotic selection guided by in vitro susceptibilities, adverse effect profiles, and clinical response. Identification and confirmation of resistance can be challenging and often requires additional testing for recognition of complex mechanisms. Current antimicrobial approaches to MDRGN infections include use of novel agents, prolonged infusion, and/or combination therapy. We also discuss preventative efforts including infection control, antimicrobial stewardship, targeted pre-emptive or prophylactic treatment, and decolonization.
Discussion:
The impact of MDRGN infections on patient and graft survival highlights the need to optimize treatment and prevention strategies.
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