Multidrug-resistant bacteria in solid organ transplant recipients

Abstract

Bacteria are the leading cause of infections after solid organ transplantation. In recent years, a progressive growth in the incidence of multidrug-resistant (MDR) and extensively-drug-reistant (XDR) strains has been observed. While methicillin-resistant Staphylococcus aureus (MRSA) infection is declining in non-transplant and SOT patients worldwide, vancomycin-resistant enterococci, MDR/XDR Enterobacteriaceae and MDR/XDR non-fermenters are progressively growing as a cause of infection in solid organ transplant (SOT) patients and represent a global threat. Some SOT patients develop recurrent infections, related to anatomical defects in many cases, which are difficult to treat and predispose patients to the acquisition of MDR pathogens. As the antibiotics active against MDR bacteria have several limitations for their use, which include less clinical experience, higher incidence of adverse effects and less knowledge of the pharmacokinetics of the drug, and, in most cases, are only available for parenteral administration, it is mandatory to know the main characteristics of these drugs to safely treat SOT patients with MDR bacterial infections. Nonetheless, preventive measures are the cornerstone of controlling the spread of these pathogens. Thus, applying the Center for Disease Control and Prevention's and the European Society of Clinical Microbiology and Infectious Diseases's recommended antibiotic policies and strategies to control the transmission of MDR strains in the hospital setting is essential for the management of SOT patients.

Risk Factors for Resistance and Mortality in Patients with Extensively Resistant Acinetobacter Bacteremia in Taleghani Hospital in Tehran, Iran

“…Some studies have investigated the factors making patients vulnerable to Acinetobacter bloodstream infections (3,22). In our study, in line with several other studies (5, 11), there was no significant relationship between underlying diseases leading to immunodeficiency and the emergence of resistance and mortality (Tables 2, 3).…”

“…However, as reported, the risk of developing resistant Acinetobacter is more associated with hospitalization and the length of stay in the hospital and the ICU, rather than underlying diseases (3,11,22).…”

“…Indeed similar to other studies, these factors in immunocompromised patients make them prone to infections caused by Acinetobacter spp. ; but other factors are more important in developing resistance (3,5,9,22).…”

Current State of Antimicrobial Stewardship at Solid Organ and Hematopoietic Cell Transplant Centers in the United States

“…Patients undergoing SOT or HCT are frequently exposed to prolonged courses of prophylactic and therapeutic antibiotics, which may contribute to the occurrence of adverse drug events (e.g., Clostridium difficile infection) and colonization and infection by multidrug-resistant organisms. 13–15 There are also growing reports of antifungal and antiviral resistance occurring in transplant patients. 16–18 Thus, efforts to optimize the selection, dosing, and duration of antimicrobial therapy both to improve patient outcomes and to minimize selective pressure are extremely relevant to this patient population.…”

Aquisição de bactéria gram-negativa multidroga resistente antes do transplante de fígado: o impacto no desfecho

“…(1) (3) In this first period, patients undergoing liver transplantation (LT) are particularly susceptible to HAI compared to patients who have been submitted to other SOT. There are certainly many factors that can contribute to this fact: the complexity of the procedure, prolonged hospital and intensive care stay, immunosuppression caused by baseline diseases, frequency of renal failure, malnutrition and hepatic failure by itself.…”