Multidrug-resistant organisms in lung transplant: a narrative review

Abstract

Purpose of reviewThe purpose of this narrative review is presenting the current knowledge of multidrug-resistant (MDR) pathogens in lung transplant recipients, considering both Gram-positive and Gram-negative bacteria.Recent findingsOverall prevalence of Gram-negative pathogens has increased remarkably (4.33/1000 recipient-days) in solid organ transplant recipients, while the prevalence of Gram-positive bacteria seems to be decreasing (0.20 cases/100 transplant-years). In lung transplant, the prevalence of postoperative infections due to MDR-GN bacteria has been assessed between 31 and 57%, and the incidence of carbapenem-resistant Enterobacterales is between 0.4 and 20%, with a related mortality up to 70%. MDR Pseudomonas aeruginosa is common in lung transplant recipients with cystic fibrosis and may contribute to bronchiolitis obliterans syndrome. The prevalence of MDR Gram-positive bacteria is around 30% (predominantly Methicillin-resistant Staphylococcus aureus and Coagulase-negative staphylococcus).SummarySurvival after lung transplant, although lower than in other SOT, is increasing and currently at 60% at 5 years. This review highlights the potential clinical and social burden of postoperative infections in lung transplant recipients, and confirmed that a PI due to MDR bacteria negatively affects survival. A prompt diagnosis, prevention and management of these MDR pathogens should remain the cornerstone for higher goals of care.

Fungal Infections and Colonization after Bilateral Lung Transplant: A Six-Year Single-Center Experience

“…Furthermore, mycophenolate mofetil was provided from 1 to 2 g/day, and methylprednisolone was provided at the dosage of 0.5 mg/kg/day [24]. In our center, we implemented a standardized protocol for microbiological surveillance based on a routine bi-weekly or thrice-weekly collection of respiratory and rectal samples from ICU admission to hospital discharge, as previously published [24][25][26]. Additionally, biological fluid samples for microbiological purposes were collected from donors [24].…”

The effect of infectious diseases on lung transplantation in Japan

“…At-risk bacterial infections include both community and hospital-acquired infections, complicated by the increasing burden of antimicrobial resistance (AMR) ( 13 , 26 ). Lung transplant recipients experience a high incidence of infection with multidrug-resistant Gram-negative bacteria, mainly comprised of extended-spectrum beta-lactamase and carbapenem-resistant Enterobacteriaceae , ranging from 31% to 57% ( 27 , 28 ). On the contrary, the incidence of multidrug-resistant Gram-positive bacteria, mainly comprised of methicillin-resistant S .…”

“…On the contrary, the incidence of multidrug-resistant Gram-positive bacteria, mainly comprised of methicillin-resistant S . aureus , is approximately 30% ( 27 , 29 ). These figures likely differ depending on region/country and affect antibiotic modification in lung transplant recipients.…”

Clinical characteristics, risk factor analysis and peripheral blood cell changes for early warning of multidrug‐resistant bacteria (MDR) infection in elderly patients

“…34 As an illustration, post-lung transplantation patients manifest an elevated incidence of gram-negative MDR infection, and MDR-related infections are recognized as significant contributors to escalated mortality subsequent to transplantation. 35 Moreover, lung infections, prevalently encountered among elderly hospitalized patients, can amplify the severity of their primary diseases and elevate mortality rates, due to their vulnerability to MDR and suboptimal choices in empirical antibiotic therapy. 36…”