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Multidrug-resistant Gram-negative bacteria in lung transplantation: a narrative review of infectious complications

Margherita Sambo1,2, Gabriele Giuliano1,2, David Bennett3

  • 1Department of Medical Biotechnologies, University of Siena, Siena, Italy.

Frontiers in Microbiology
|December 26, 2025
PubMed

Insights

Multidrug-resistant Gram-negative bacterial infections are a significant concern in lung transplantation but no longer a contraindication. Updated antimicrobial strategies are crucial for managing these infections in transplant recipients.

Area of Science:

  • Infectious Diseases
  • Transplantation Medicine
  • Antimicrobial Resistance

Background:

  • Multidrug-resistant Gram-negative bacteria (MDR-GNB) pose a significant threat in lung transplantation (LuTx), linked to adverse outcomes.
  • Limited effective antimicrobial options exacerbate the challenge of MDR-GNB in LuTx recipients.
  • MDR-GNB colonization or infection is not an absolute contraindication for LuTx.

Purpose of the Study:

  • To review the epidemiology of infections in LuTx recipients, focusing on MDR-GNB.
  • To explore current evidence on diagnostic, prophylactic, and therapeutic strategies for MDR-GNB in LuTx.
  • To identify knowledge gaps and emphasize the need for further research.

Main Methods:

  • Literature review of recent recommendations and evidence.
  • Analysis of epidemiological data concerning MDR-GNB in LuTx.
  • Synthesis of information on antimicrobial strategies, diagnostics, and prophylaxis.

Main Results:

  • Updated recommendations from expert societies guide antimicrobial strategies for MDR-GNB in LuTx.
  • Established and novel antimicrobial agents are considered in treatment plans.
  • MDR-GNB management requires a comprehensive approach including diagnostics and prophylaxis.

Conclusions:

  • Despite challenges, lung transplantation is feasible in the context of MDR-GNB infections.
  • Optimized prevention and treatment strategies are essential for high-risk LuTx populations.
  • Further research is needed to address remaining knowledge gaps in MDR-GNB management post-LuTx.
Keywords:
antibiotic prophylaxisdifficult to treat infectionsimmunocompromised hostlung transplantationmultidrug resistant Gram-negative bacteria

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