Incidence and Outcomes Associated With Clostridioides difficile Infection in Solid Organ Transplant Recipients

Background:The consequences of inappropriate antimicrobial use including resistance are increasingly recognized as a global public health threat and many steps have been taken over the last few decades to advance antimicrobial stewardship initiatives with most organ transplant centers currently part of institutions with active antimicrobial stewardship programs.Methods: A review of the literature was conducted and articles were categorized according to the topic and relevance in the judgment of the two authors.Results: A summary review of the currently available literature was created with a focus on periprocedural and outpatient antimicrobial stewardship. Limitations in the data were significant and discussed in the review. Conclusion:The principles of antimicrobial stewardship remain important throughout all phases starting with periprocedural prophylactic antimicrobial selection all the way through to discharge and subsequent healthcare encounters. Despite the broad advances in stewardship initiatives and the rapidly progressing supportive data overall there continue to be significant opportunities for additional research within various special patient populations including recipients of solid organ transplantation (SOT).The recent white paper published in the American Journal of Transplantation called to action the transplant and stewardship communities to have an increased focus and awareness of the issues that antimicrobial overuse can present in the SOT patient population. This is an important step that will hopefully generate more data in this group of patients that arguably faces the greatest vulnerability to the consequences of increased antimicrobial resistance.

Section: Peri‐operative Antimicrobial Stewardshipmentioning

confidence: 99%

Section: Peri‐operative Antimicrobial Stewardshipmentioning

confidence: 99%

Outpatient and peri‐operative antibiotic stewardship in solid organ transplantation

Kinn

İnce

2022

“…57 CDI rates may represent a particularly salient metric, as SOT recipients are known to have higher rates of infection and increased morbidity, mortality, and costs associated with CDI than the general population. 58,59 Additionally, CDI is one of the few outcome measures in the general stewardship population where ASP has consistently been shown to have a positive impact, including on mortality. 3 Accordingly, CDI rates are the most commonly utilized outcome metric in SOT programs, with 56% of programs in a recent survey using this metric.…”

Section: Outcome Metricsmentioning

confidence: 99%

Antimicrobial stewardship in solid organ transplant recipients: Current challenges and proposed metrics

Raglow

Advani

Aitken

et al. 2022

Background Solid organ transplant (SOT) recipients are challenging populations for antimicrobial stewardship interventions due to a variety of reasons, including immunosuppression, consequent risk of opportunistic and donor‐derived infections, high rates of infection with multi‐drug resistant organisms (MDROs), Clostridioides difficile, and need for prolonged antimicrobial prophylaxis. Despite this, data on stewardship interventions and metrics that address the distinct needs of these patients are limited. Methods We performed a narrative review of the current state of antimicrobial stewardship in SOT recipients, existing interventions and metrics in this population, and considerations for implementation of transplant‐specific stewardship programs. Results Antimicrobial stewardship metrics are evolving even in the general patient population. Data on metrics applicable to the SOT population are even more limited. Standard process, outcomes, and balancing metrics may not always apply to the SOT population. A successful stewardship program for SOT recipients requires reviewing existing data, applying general stewardship principles, and understanding the nuances of SOT patients. Conclusion As antimicrobial stewardship interventions are being implemented in SOT recipients; new metrics are needed to assess their impact. In conclusion, SOT patients present a challenging but important opportunity for antimicrobial stewards. Abbreviations SOT, antimicrobial stewardship program, MDRO, Clostridioides difficile infection, Centers for Disease Control and Prevention, Infectious Diseases Society of America, prospective audit and feedback, hematopoietic cell transplant, cytomegalovirus, trimethoprim‐sulfamethoxazole, surgical site infections, nucleic acid amplification testing, days of therapy, defined daily dose, and length of stay.

“…Antibiotics active against these bacteria have several limitations, such as a lack of data on efficacy and outcomes in SOT recipients, a lesser‐known rate of adverse events, and, especially important, most are only available for parenteral administration, making it impossible for a swift hospital discharge 8 . Finally, the overuse of antibiotics is responsible for the increasing trends of Clostridioides difficile infection (CDI) in SOT recipients, which is associated with more frequent recurrences, graft loss, and mortality 9 …”

Section: Introductionmentioning

confidence: 99%

“…8 Finally, the overuse of antibiotics is responsible for the increasing trends of Clostridioides difficile infection (CDI) in SOT recipients, which is associated with more frequent recurrences, graft loss, and mortality. 9 …”

Section: Introductionmentioning

confidence: 99%

Current state of antimicrobial stewardship and organ transplantation in Spain

Silva

Paz‐Artal

2022

Introduction Solid‐organ transplantation (SOT) remains the best therapeutic option for end‐stage organ disease. Regrettably, SOT recipients are disproportionately affected by nosocomial infections produced by multidrug‐resistant (MDR) microorganisms and antimicrobial adverse events. Both have a negative impact on the patient´s outcome. Methods Description of data concerning the antimicrobial stewardship program (ASP) in SOT recipients of the University Hospital “12 de Octubre”, and review of other Spanish ASPs. Results From May 2017 to December 2021, the ASP issued 2.785 recommendations. Approximately, 4.9% were aimed at improving the antimicrobial treatment administered to SOT recipients. Treatment discontinuation or change to a better therapeutic regimen was recommended in 51.8% and 26.3% of cases, respectively. The acceptance rate of the recommendations was close to 92%. Between June 2015 and March 2016, a quasi‐experimental study consisting of a joint ASP and hospital‐acquired infection control (HAIC) initiative, which included kidney transplant recipients, reported a significant reduction in the consumption of meropenem, vancomycin and ciprofloxacin, and a reduction in the incidence of global bacterial infections, upper urinary tract infections, and cystitis. Although Spain has several robust regional ASPs (e.g., VINCat and PIRASOA), data specifically concerning SOT patients is lacking. Conclusion ASP coupled with HAIC programs have proven to be effective in SOT, and should be implemented in centers that perform transplantation. Since data is scarce, Spanish centers which have ASP should report their experience in SOT. Understanding the efficacy and safety of the Spanish ASP´s intervention in the SOT population is essential and deserves further study.