Prevalence of carbapenemase‐producing organisms among hospitalized solid organ transplant recipients, five US hospitals, 2019–2020

Chan, Joshua C. C.; Nazarian, Elizabeth; Musser, Kimberlee A.; Snavely, Emily; Fung, Monica; Doernberg, Sarah B; Pouch, Stephanie M.; Leekha, Surbhi; Anesi, Judith A; Kodiyanplakkal, Rosy Priya; Turbett, Sarah E; Epstein, Lauren

doi:10.1111/tid.13785

Cited by 6 publications

(2 citation statements)

References 31 publications

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“…78,79 SOTRs have a higher baseline risk of antibiotic-associated adverse outcomes. Among SOTRs, multidrug resistant (MDR) infection is common and increasingly prevalent [80][81][82] and is associated with worse graft and/or patient survival. 59,[83][84][85] CDI is common among nonkidney SOTRs [86][87][88] and is associated with significant morbidity: increased risk of graft rejection, 89 longer LOS, 86,90 higher risk of hospital readmission, 90 and higher risk of mortality.…”

Section: Harms Associated With Antibioticsmentioning

confidence: 99%

Shorter is better: The case for short antibiotic courses for common infections in solid organ transplant recipients

Imlay

Spellberg

2022

Transplant Infectious Dis

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Background: Prolonged antibiotics are associated with toxicity, selection for resistant organisms, and secondary infections such as Clostridioides difficile colitis. Emerging clinical data suggest that short courses of antibiotics can be used for common bacterial infections among immune competent patients, but for many randomized controlled trials (RCTs), immunocompromised patients, including solid organ transplant recipients (SOTRs), have been excluded.Methods: Peer-reviewed publications were identified through PubMed and Embase searches. Results:We review data examining shorter antibiotic courses among immunocompetent and immunocompromised patients and the rationale for use of short antibiotic courses in SOTRs. Conclusion:There are known harms associated with antibiotics and, when studied, existing data do not demonstrate harm associated with shorter courses of antibiotics among SOTRs. Furthermore, several RCTs did include some immune compromised patients and found shorter therapy to result in similar clinical efficacy with diminished adverse effects. Shorter antibiotic durations should be considered in SOTRs, and questions of antibiotic duration among SOTRs should be prioritized for study in clinical trials.

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Section: Harms Associated With Antibioticsmentioning

confidence: 99%

Shorter is better: The case for short antibiotic courses for common infections in solid organ transplant recipients

Imlay

Spellberg

2022

Transplant Infectious Dis

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“…Antibiotics have saved millions of lives in the modern medical era and helped pave the way for modern surgical development, including solid organ transplantation 1,2 . However, in the setting of immunosuppression, anatomic issues that arise after surgery, donor‐derived infections, and use of antibiotics, infections due to multidrug‐resistant organisms (MDROs) are rising 3–9 . While prevention of these infections remains critical, we must also maintain access to antibacterial agents for when MDRO infections do occur.…”

Section: The Current State Of Clinical Trials For New Antibioticsmentioning

confidence: 99%

Desirability of outcome ranking and quality life measurement for antimicrobial research in organ transplantation

Doernberg

2022

Transplant Infectious Dis

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Background: Current clinical trials of new antibiotics facilitate bringing new drugs to market but often fail to provide useful information for clinical decision making. Methods: Literature review of desirability of outcome ranking (DOOR) in antibiotic clinical trials and description how DOOR can fit into design, administration, and assessment of clinical trials. Results: DOOR is an approach that addresses many of the shortcomings of current trials by incorporating efficacy and safety into a single outcome to analyze the patient experience in its entirety. Application of partial credit, tiebreaker strategies including response adjusted for duration of antibiotic risk (RADAR), and DOOR for Management of Antimicrobial Therapy (DOOR MAT) provides additional nuance and granularity. To address pitfalls of DOOR, investigators must develop the DOOR a priori, ideally with input from and incorporation of patient voices, and should perform component analysis to ensure that imbalances in key components are detected. Conclusion: Inclusion of DOOR in clinical trials will enrich our understanding of how new antibiotics might benefit patients who have had transplantation. Additional work to develop best practices for DOOR selection, analysis, and interpretation must continue, and incorporation of the patient perspective is essential. K E Y W O R D S antibiotic-resistant bacteria, clinical trial design, desirability of outcome ranking, health-related quality of life THE CURRENT STATE OF CLINICAL TRIALS FOR NEW ANTIBIOTICSAntibiotics have saved millions of lives in the modern medical era and helped pave the way for modern surgical development, including solid organ transplantation. 1,2 However, in the setting of immunosuppression, anatomic issues that arise after surgery, donor-derived

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Challenges of Antimicrobial Resistance and Stewardship in Solid Organ Transplant Patients

Walti

2022

Curr Infect Dis Rep

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Purpose of Review Without effective antimicrobials, patients cannot undergo transplant surgery safely or sustain immunosuppressive therapy. This review examines the burden of antimicrobial resistance in solid organ transplant recipients and identifies opportunities for antimicrobial stewardship. Recent Findings Antimicrobial resistance has been identified to be the leading cause of death globally. Multidrug-resistant pathogens are associated with significant morbidity and mortality in transplant recipients. Methicillin-resistant S. aureus affects liver and lung recipients, causing bacteremia, pneumonia, and surgical site infections. Vancomycin-resistant enterococci is a nosocomial pathogen primarily causing bacteremia in liver recipients. Multidrug-resistant Gram-negative pathogens present urgent and serious threats to transplant recipients. Extended-spectrum beta-lactamase-producing E. coli and K. pneumoniae commonly cause bacteremia and intra-abdominal infections in liver and kidney recipients. Carbapenemase-producing Enterobacterales, mainly K. pneumoniae , are responsible for infections early-post transplant in liver, lung, kidney, and heart recipients. P. aeruginosa and A. baumannii continue to be critical threats. While there are new antimicrobial agents targeting resistant pathogens, judicious prescribing is crucial to minimize emerging resistance. The full implications of the COVID-19 global pandemic on antimicrobial resistance in transplant recipients remain to be understood. Currently, there are no established standards on the implementation of antimicrobial stewardship interventions, but strategies that leverage existing antimicrobial stewardship program structure while tailoring to the needs of transplant recipients may help to optimize antimicrobial use. Summary Clinicians caring for transplant recipients face unique challenges tackling emerging antimcirobial resistance. Coordinated antimicrobial stewardship interventions in collaboration with appropriate expertise in transplant and infectious diseases may mitigate against such threats.

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Prevalence of carbapenemase‐producing organisms among hospitalized solid organ transplant recipients, five US hospitals, 2019–2020

Cited by 6 publications

References 31 publications

Shorter is better: The case for short antibiotic courses for common infections in solid organ transplant recipients

Shorter is better: The case for short antibiotic courses for common infections in solid organ transplant recipients

Desirability of outcome ranking and quality life measurement for antimicrobial research in organ transplantation

Challenges of Antimicrobial Resistance and Stewardship in Solid Organ Transplant Patients

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