Outpatient and peri‐operative antibiotic stewardship in solid organ transplantation

Abstract

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.

“Electronic Phenotyping” Antimicrobials to Facilitate Outpatient Stewardship for Asymptomatic Bacteriuria and Urinary Tract Infection in Renal Transplant

“…Implementation of antimicrobial stewardship principles is increasingly necessary within solid organ transplant (SOT) given rising rates of antimicrobial resistance and infection with multidrug-resistant organisms [ 1 , 2 ]. However, few data exist to guide evaluation of stewardship initiatives in outpatient SOT clinics.…”

“…However, few data exist to guide evaluation of stewardship initiatives in outpatient SOT clinics. Asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) in renal transplant (RT) represents one domain in which antimicrobial stewardship programs (ASPs) may seek to optimize outpatient antibiotic use in SOT given high-quality data to guide stewardly practices [ 2 , 3 ].…”

Antimicrobial stewardship in solid organ transplantation—A call for action!

“…New outcomes metrics, 5 how to measure antibiotic use, and stewardship of antifungals 6 and antivirals 7 . Also, diagnostic stewardship, short course antimicrobial therapy in the transplant recipient, 8 allergy delabeling, 9 and perioperative and outpatient stewardship, 10 all areas that need addressing in the real world of transplantation.…”