Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations

Abstract

Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate's phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.

Infections due to multidrug‐resistant organisms following heart transplantation: Epidemiology, microbiology, and outcomes

“…These findings are similar to published literature that heart transplant recipients are at high risk of pulmonary infections, particularly in the early post‐HT period . Other commonly reported types of post‐HT infection include UTI, mediastinitis, and vascular catheter‐related BSI . The majority of infections in our cohort were due to gram‐negative bacteria.…”

“…12,13 Other commonly reported types of post-HT infection include UTI, mediastinitis, and vascular catheter-related BSI. [13][14][15] The majority of infections in our cohort were due to gram-negative bacteria. This has been described for the SOT population in general, 13 but limited information is available specific to HT recipients.…”

Microbiological findings in bronchoalveolar lavage fluid from lung transplant patients in Sweden

“…In a recent publication, Rodrigo‐Troyano et al describes the serious threat posed by Gram‐negative MDR bacteria in respiratory infections. In fact, management of MDR bacteria in solid organ transplanted patients is a major issue of concern in most countries . In our samples, most Gram‐negative bacteria were susceptible to carbapenem treatment and no MDR Gram‐positive bacteria were found.…”

Comparison in outcome with tailored antibiotic prophylaxis postoperatively in pediatric intestinal transplant population

“…Preoperative and intraoperative anti‐infective prophylaxis protocols aid in priming the organ recipient against common gram‐negative and gram‐positive organisms while their baseline immunity is intact. When the transplantation is complete, postoperative anti‐infective prophylaxis provides protection against newly introduced organisms as well as remaining organisms colonized in the recipient …”

“…When the transplantation is complete, postoperative anti-infective prophylaxis provides protection against newly introduced organisms as well as remaining organisms colonized in the recipient. 8 Prior to 2013, the Miami Transplant Institute Pediatric Service permits recurrent bloodstream infections. 9 With each course of antibiotics to address each bloodstream infection, these patients take steps to development of more and more resistant organisms.…”