Not Just an Oxymoron: The Utilitarian's Guide to Antimicrobial Stewardship in Transplant Infectious Diseases

Area of Science:

• Infectious Diseases
• Transplant Medicine
• Antimicrobial Stewardship

Background:

• Transplant recipients are immunocompromised, increasing susceptibility to infections and multidrug-resistant organisms (MDROs).
• High antibiotic exposure in these patients further elevates MDRO risk.
• Antimicrobial Stewardship Programs (ASP) are vital for optimizing antibiotic use and reducing MDROs.

Purpose of the Study:

• To review essential components for implementing ASP in transplant infectious diseases (TID).
• To guide programs establishing or expanding ASP to include TID.
• To foster collaboration between ASP and transplant programs for improved patient care.

Main Methods:

• Review of key components for ASP implementation in TID.
• Discussion of specific goals, structure, funding, and initiatives.
• Emphasis on antibiotic allergy delabeling, diagnostic stewardship, and antiviral/antifungal stewardship.

Main Results:

• Collaboration between ASP and transplant programs is evolving but essential.
• Effective ASP implementation can mitigate infection risks and reduce associated costs.
• Structured approaches to ASP in TID are necessary for optimal outcomes.

Conclusions:

• Implementing robust ASP in TID is critical for managing infections in transplant patients.
• Enhanced collaboration and targeted stewardship initiatives are needed.
• This review provides a framework for developing and growing ASP in TID settings.