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Updated: Jul 3, 2025
Author Spotlight: Investigating the Key Factors of Obliterative Bronchiolitis After Lung Transplantation
Published on: November 10, 2023
Management of infectious disease syndromes in thoracic organ transplants and mechanical circulatory device
Me-Linh Luong1, Yoshiko Nakamachi2, Fernanda P Silveira3
1Department of Medicine, Division of Infectious Diseases, CHUM, Montreal, Quebec, Canada.
Purpose:
Antimicrobial misuse contributes to antimicrobial resistance in thoracic transplant (TTx) and mechanical circulatory support (MCS) recipients. This study uses a modified Delphi method to define the expected appropriate antimicrobial prescribing for the common clinical scenarios encountered in TTx and MCS recipients.
Methods:
An online questionnaire on managing 10 common infectious disease syndromes was submitted to a multidisciplinary Delphi panel of 25 experts from various disciplines. Consensus was predefined as 80% agreement for each question. Questions where consensus was not achieved were discussed during live virtual live sessions adapted by an independent process expert.
Results:
An online survey of 62 questions related to 10 infectious disease syndromes was submitted to the Delphi panel. In the first round of the online questionnaire, consensus on antimicrobial management was reached by 6.5% (4/62). In Round 2 online live discussion, the remaining 58 questions were discussed among the Delphi Panel members using a virtual meeting platform. Consensus was reached among 62% (36/58) of questions. Agreement was not reached regarding the antimicrobial management of the following six clinical syndromes: (1) Burkholderia cepacia pneumonia (duration of therapy); (2) Mycobacterium abscessus (intra-operative antimicrobials); (3) invasive aspergillosis (treatment of culture-negative but positive BAL galactomannan) (duration of therapy); (4) respiratory syncytial virus (duration of antiviral therapy); (5) left ventricular assist device deep infection (initial empirical antimicrobial coverage) and (6) CMV (duration of secondary prophylaxis).
Conclusion:
This Delphi panel developed consensus-based recommendations for 10 infectious clinical syndromes seen in TTx and MCS recipients.
Insights
Antimicrobial misuse is a problem in thoracic transplant and mechanical circulatory support patients. This study developed expert consensus recommendations for appropriate antimicrobial prescribing in these vulnerable populations.
Area of Science:
- Infectious Diseases
- Transplantation
- Critical Care Medicine
Background:
- Antimicrobial misuse is a significant driver of antimicrobial resistance.
- Thoracic transplant (TTx) and mechanical circulatory support (MCS) recipients are particularly vulnerable to infections and antimicrobial resistance.
- Standardized antimicrobial prescribing guidelines are lacking for common infections in TTx and MCS patients.
Purpose of the Study:
- To establish consensus-based recommendations for appropriate antimicrobial prescribing in TTx and MCS recipients.
- To address antimicrobial misuse and combat antimicrobial resistance in these patient populations.
- To define optimal antimicrobial management for 10 common infectious disease syndromes.
Main Methods:
- A modified Delphi method was employed, involving a multidisciplinary panel of 25 experts.
- An online questionnaire with 62 questions on managing infectious syndromes was administered.
- Consensus was defined as 80% agreement, with unresolved questions addressed in virtual live discussion sessions.
Main Results:
- Consensus was achieved for 36 out of 58 initially unresolved questions after virtual discussions.
- Agreement was not reached on the antimicrobial management of six specific clinical syndromes, including Burkholderia cepacia pneumonia and invasive aspergillosis.
- Key areas of disagreement included duration of therapy, intra-operative antimicrobial use, and initial empirical coverage.
Conclusions:
- The Delphi panel successfully developed consensus-based recommendations for 10 infectious clinical syndromes in TTx and MCS recipients.
- These recommendations aim to guide appropriate antimicrobial use and mitigate resistance.
- Further research may be needed to resolve disagreements on specific complex cases.
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