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Published on: August 30, 2018
International Survey on Antibiotic Prophylaxis Approaches for Solid Organ Transplant Recipients and Donors Colonized
Julia Bini Viotti1,2, Stephanie M Pouch3, Maddalena Giannella4,5
1University of Miami, Miami, Florida, USA.
Background:
Multidrug-resistant organism colonization and infections cause significant morbidity and mortality in solid organ transplantation, affecting the perioperative antibiotic management. Yet, international practices for screening and antibiotic prophylaxis in colonized donors and recipients remain poorly defined.
Methods:
Self-administered, web-based survey conducted between February and July 2025 to assess global practices in multidrug-resistant organism screening and perioperative antibiotic management in SOT, developed by transplant infectious diseases experts and endorsed by the Transplant Infectious Diseases Section of the Transplantation Society and the European Society of Clinical Microbiology and Infectious Diseases Study Group for Infections in Compromised Hosts. Data collected included respondent and institution characteristics; screening and prophylaxis protocols; donor and recipient colonization management; and timeframes relevant for prophylaxis modification.
Results:
Responses from 125 transplant centers across 24 countries and four continents were included. Most respondents were infectious disease physicians (73.6%). Antimicrobial stewardship programs and transplant infectious diseases consultation were available in 93.6% and 85.6% of centers, respectively. Over half (52.0%) modified prophylaxis based on donor multidrug-resistant organism colonization, mainly triggered by urine and respiratory cultures. Preservation fluid and surveillance cultures influenced decisions less often. Recipient screening protocols were reported by 61.6% of centers, primarily targeting carbapenem-resistant Enterobacterales (80.8%). About 41.6% routinely adjusted prophylaxis for colonized recipients, especially with recent (1-3 months) colonization.
Conclusion:
Substantial international variability exists in multidrug-resistant organism screening and perioperative prophylaxis practices in solid organ transplantation. Evidence-based consensus guidelines are needed to standardize and improve prevention of donor-derived and recipient infections globally.
Insights
Practices for screening multidrug-resistant organisms (MDROs) and antibiotic prophylaxis in solid organ transplantation (SOT) vary significantly worldwide. Standardized guidelines are crucial to prevent infections in donors and recipients.
Area of Science:
- Transplantation Medicine
- Infectious Diseases
- Antimicrobial Stewardship
Background:
- Multidrug-resistant organism (MDRO) colonization and infections pose significant risks in solid organ transplantation (SOT), impacting perioperative antibiotic management.
- Current international practices for screening and antibiotic prophylaxis in colonized donors and recipients are poorly defined.
Purpose of the Study:
- To assess global practices in MDRO screening and perioperative antibiotic management within SOT.
- To identify international variability in protocols for managing colonized donors and recipients.
Main Methods:
- A web-based survey was administered globally to transplant centers from February to July 2025.
- The survey, developed by transplant infectious diseases experts, collected data on screening protocols, prophylaxis, and colonization management.
- Endorsement by relevant professional societies ensured expert input and broad reach.
Main Results:
- Responses from 125 centers across 24 countries revealed substantial international variability in MDRO screening and prophylaxis.
- Over half of centers modified prophylaxis based on donor MDRO colonization, primarily from urine and respiratory cultures.
- Recipient screening targeted carbapenem-resistant Enterobacterales, with over 40% adjusting prophylaxis for recently colonized recipients.
Conclusions:
- Significant international variation exists in MDRO screening and perioperative prophylaxis practices for SOT.
- There is a critical need for evidence-based consensus guidelines to standardize practices and improve infection prevention globally.
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