Survey on the approach to antibiotic prophylaxis in liver and kidney transplant recipients colonized with “difficult to treat” Gram‐negative bacteria

Abstract

BackgroundPerformance of active screening for multidrug‐resistant Gram‐negative bacteria (MDR‐GNB) and administration of targeted antibiotic prophylaxis (TAP) in colonized patients undergoing liver (LT) and/or kidney transplantation (KT) are controversial issues.MethodsSelf‐administered electronic cross‐sectional survey disseminated from January to February 2022. Questionnaire consisted of four parts: hospital/transplant program characteristics, standard screening and antibiotic prophylaxis, clinical vignettes asking for TAP in patients undergoing LT and KT with prior infection/colonization with four different MDR‐GNB (extended‐spectrum cephalosporin‐resistant Enterobacterales [ESCR‐E], carbapenem‐resistant Enterobacterales [CRE], multidrug‐resistant Pseudomonas aeruginosa [MDR‐Pa], and carbapenem‐resistant Acinetobacter baumannii [CRAb]).ResultsFifty‐five respondents participated from 14 countries, mostly infectious disease specialists (69%) with active transplant programs (>100 procedures/year for 34.5% KT and 23.6% LT), and heterogeneous local MDR‐GNB prevalence from <15% (30.9%), 15%–30% (43.6%) to >30% (16.4%). The frequency of screening for ESCR‐E, CRE, MDR‐Pa, and CRAb was 22%, 54%, 17%, and 24% for LT, respectively, and 18%, 36%, 16%, and 11% for KT. Screening time‐points were mainly at transplantation 100%, only one‐third following transplantation. Screening was always based on rectal swab cultures (100%); multi‐site sampling was reported in 40% of KT and 35% of LT. In LT clinical cases, 84%, 58%, 84%, and 40% of respondents reported TAP for prior infection/colonization with ESCR‐E, CRE, MDR‐Pa, and CRAb, respectively. In KT clinical cases, 55%, 39%, 87%, and 42% of respondents reported TAP use for prior infection/colonization with ESCR‐E, CRE, MDR‐Pa, and CRAb, respectively.ConclusionThere is a large heterogeneity in screening and management of MDR‐GNB carriage in LT and KT. image