Antimicrobial stewardship in solid organ transplant—Opportunities in the National Health Service

Abstract

Background Antimicrobial stewardship (AMS) is an intervention, which ensures the appropriateness of antimicrobial use to avoid in part the rising problem of antimicrobial resistance and negative effects of inappropriate antimicrobial use. In the solid organ transplant (SOT) population, which is prone to a particularly high risk of infection resulting from immunosuppression and anatomical issues with each type of SOT, the need for good stewardship has never been more important. This article looks at current AMS practice in SOT units in the United Kingdom and how things could be improved in the future. Methods The current practice of AMS alongside national antimicrobial resistance rates were reviewed using national mandatory reporting data. The background to the current practice and policies in place in the National Health Service (NHS) were also reviewed and possibilities for future approaches explored. Results AMS is a requirement within all NHS hospitals in the United Kingdom as per government policy. Mandatory reporting of specific bloodstream infections (BSIs) and antimicrobial consumption alongside financial incentives has been the approach nationwide. Gram‐negative resistance rates in BSIs have been increasing prior to the COVID‐19 pandemic. Little SOT‐specific data on antimicrobial resistance exists, and the general approach to AMS in SOT units has generally modeled the national approach. Conclusion Although there is a good, standardized approach to AMS in the NHS, there is a need for SOT‐specific AMS approaches to be developed in the United Kingdom. More data is required on antimicrobial resistance rates, and studies are needed to investigate optimal antimicrobial prophylaxis regimens for each solid organ group. Tools to aid AMS efforts and novel treatment options for complex multiresistant infection must also be explored amongst transplant centers.

Antibiotic Stewardship in Surgical Departments

“…Antibiotic stewardship is a very important issue in patients undergoing surgery for solid organ transplants (SOTs) [73,74]. The consequences of inappropriate antimicrobial use such as drug toxicities, MDR organism infection, and C. difficile infection (CDI) disproportionately affect recipients of SOT, and they are associated with poor allograft and patient outcomes [75].…”

“…Prophylaxis in SOT should ideally be tailored to pre-existing known colonization or chronic infection. Cultures of the transport fluid may also help [73]. With appropriate interventions regarding surgical prophylaxis and feedback to the surgical departments, AS has proven beneficial in decreasing SSIs, the number and costs of antibiotics used, and antimicrobial resistance in SOT [76].…”