Management of Multidrug Resistant Infections in Lung Transplant Recipients with Cystic Fibrosis

Vazirani, Jaideep; Crowhurst, Thomas; Morrissey, C. Orla; Snell, Gregory I

doi:10.2147/idr.s301153

Cited by 5 publications

(5 citation statements)

References 95 publications

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“…Infection with carbapenem-resistant Enterobacteriaceae can range from 1 to 18% amongst solid organ transplant (SOT) recipients and 16-24% in stem cell transplant (SCT) recipients [18]. Cystic fibrosis (CF) patients awaiting lung transplant have high rates of MDR Pseudomonas and Mycobacterium abscessus, whilst many centres list the presence of Burkholderia cepacia complex as a contraindication to lung transplant [19][20][21]. The presence of MDROs is associated with worse illness [22] and increased mortality while awaiting transplant, but there are mixed reports of changes in posttransplant outcomes [23][24][25][26][27].…”

Section: Multidrug-resistant Infections In Transplant Recipientsmentioning

confidence: 99%

Role of bacteriophage therapy for resistant infections in transplant recipients

Nicholls

Aslam

2022

Current Opinion in Organ Transplantation

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Purpose of reviewMultidrug-resistant organisms (MDROs) are prevalent in transplant recipients and associated with poor outcomes. We review recent cases of phage therapy used to treat recalcitrant infections in transplant recipients and explore the future role of such therapy in this setting.Recent findingsIndividual case reports and small case series suggest possible efficacy of phage therapy for the treatment of MDRO infections in pre and posttransplant patients. Importantly, there have been no serious safety concerns in the reported cases that we reviewed. There are no applicable randomized controlled trials (RCTs) to better guide phage therapy at this time.SummaryGiven the safety and possibility of successful salvage therapy of MDRO infections using bacteriophages, it is reasonable to pursue phage therapy for difficult-to-treat infections on a compassionate use basis, but RCT data are critically needed to better inform management.

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Section: Multidrug-resistant Infections In Transplant Recipientsmentioning

confidence: 99%

Role of bacteriophage therapy for resistant infections in transplant recipients

Nicholls

Aslam

2022

Current Opinion in Organ Transplantation

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“…Of the latter, those caused by Scedosporium spp. and L. prolificans are the most frequent and related to poor outcome [12,29–31,32 ▪ ].…”

Section: Mould Infections: Aspergillus Scedosporium Spp and Lomentosp...mentioning

confidence: 99%

“…The most common dangerous species is B. cenocepacia. It has been associated with extreme multidrug resistance, a more rapid decline in lung function pretransplant and mortality after transplant [12,51].…”

Section: Burkholderia Cepacia Complexmentioning

confidence: 99%

“…Drugs as tigecycline, dual beta-lactam agents (imipenem with ceftaroline or ceftazidime) with or without a betalactamase inhibitor (avibactam, relebactam) moxifloxacin, clofazimine, minocycline and beda-quiline have been incorporated to M. abscessus management due to low minimum inhibitory concentration (MIC) in vitro. However, a low MIC does not imply a favourable outcome, in fact the activity of oral drugs for M. abscessus is marginal at best, regardless of the MIC [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Multiresistant organisms: bacteria and beyond

Solé¹

2022

Current Opinion in Organ Transplantation

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Purpose of reviewInfections with multiresistant organisms are an emerging problem, cause early mortality post lung transplantation and are sometimes associated with graft dysfunction. Frequently they raise questions about the selection of lung transplant candidates and therapeutic management post lung transplantation. There are no guidelines and management must be individualized. This review summarizes the available therapeutic options in cases of multidrug-resistant (MDR) organisms and outcomes after lung transplant.Recent findingsImprovements in diagnosis, new and more effective drugs and the experience gained in the management of these infections in lung transplantation, lead to a more optimistic horizon than that found a decade ago.SummaryUpdate on the management of Burkholderia cepacia complex, Mycobacterium abscessus complex, Aspergillus spp., Scedosporium spp. and Lomentospora prolificans infections. This review clarifies current posttransplant outcomes and adds a little hope in these scenarios.

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“…and Burkholderia spp. are diverse and important opportunistic pathogens ( 1 ) that are increasingly found in patients with cystic fibrosis (CF) ( 2 , 3 ) and are frequent causes of infection following lung transplantation ( 3 – 5 ). Common Achromobacter infections in individuals without CF are pneumonia and bacteremia, which are generally hospital acquired ( 3 , 6 ), although many bloodstream infections have a community onset ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

In vitro and in vivo activity of cefiderocol against Achromobacter spp. and Burkholderia cepacia complex, including carbapenem-non-susceptible isolates

Takemura,

Nakamura,

Ota

et al. 2023

Antimicrob Agents Chemother

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Achromobacter spp. and Burkholderia cepacia complex (Bcc) are rare but diverse opportunistic pathogens associated with serious infections, which are often multidrug resistant. This study compared the in vitro antibacterial activity of the siderophore antibiotic cefiderocol against Achromobacter spp. and Bcc isolates with that of other approved antibacterial drugs, including ceftazidime-avibactam, ciprofloxacin, colistin, imipenem-relebactam, and meropenem-vaborbactam. Isolates were collected in the SIDERO multinational surveillance program. Among 334 Achromobacter spp. isolates [76.6% from respiratory tract infections (RTIs)], cefiderocol had minimum inhibitory concentration (MIC) 50/90 of 0.06/0.5 µg/mL overall and 0.5/4 µg/mL against 52 (15.6%) carbapenem-non-susceptible (Carb-NS) isolates. Eleven (3.3%) Achromobacter spp. isolates overall and 6 (11.5%) Carb-NS isolates were not susceptible to cefiderocol. Among 425 Bcc isolates (73.4% from RTIs), cefiderocol had MIC 50/90 of ≤0.03/0.5 µg/mL overall and ≤0.03/1 µg/mL against 184 (43.3%) Carb-NS isolates. Twenty-two (5.2%) Bcc isolates overall and 13 (7.1%) Carb-NS isolates were not susceptible to cefiderocol. Cumulative MIC distributions showed cefiderocol to be the most active of the agents tested in vitro against both Achromobacter spp. and Bcc. In a neutropenic murine lung infection model and a humanized pharmacokinetic immunocompetent rat lung infection model, cefiderocol showed significant bactericidal activity against two meropenem-resistant Achromobacter xylosoxidans strains compared with untreated controls ( P < 0.05) and vehicle-treated controls ( P < 0.05), respectively. Meropenem, piperacillin-tazobactam, ceftazidime, and ciprofloxacin comparators showed no significant activity in these models. The results suggest that cefiderocol could be a possible treatment option for RTIs caused by Achromobacter spp. and Bcc.

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Management of Multidrug Resistant Infections in Lung Transplant Recipients with Cystic Fibrosis

Cited by 5 publications

References 95 publications

Role of bacteriophage therapy for resistant infections in transplant recipients

Role of bacteriophage therapy for resistant infections in transplant recipients

Multiresistant organisms: bacteria and beyond

In vitro and in vivo activity of cefiderocol against Achromobacter spp. and Burkholderia cepacia complex, including carbapenem-non-susceptible isolates

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