Prevention of infections in solid organ transplant recipients

Abstract

Solid organ transplantation has become an important therapeutic option for multiple chronic diseases. With the advent of newer and potent immunosuppressive regimens, graft survival has improved, but at the expense of an increased risk for the development of infections secondary to bacterial, fungal, viral and parasitic pathogens. Prevention of such infectious complications with effective, well tolerated, and cost-effective anti-microbials would be ideal to improve the outcome of transplanted patients. However, the emergence of multi-drug resistant pathogens, medication toxicity and drug-drug interactions need to be carefully evaluated. This review summarizes the most relevant data pertaining to our current understanding of infection prevention for solid organ transplant recipients. Specific recommendations are given for the prevention of each group of microorganisms and types of solid organ transplant.

Post-operative Nosocomial Infections After Lung and Heart Transplantation

“…22 The presently reported pathogens responsible for pneumonia are consistent with reports in the literature. 19,23 Interestingly, compared with non-transplant surgical patients, P aeruginosa and other gram-negative rods were the leading pathogens rather than S aureus.…”

Clinical practice guidelines for antimicrobial prophylaxis in surgery

“…The routine use of vancomycin as antimicrobial prophylaxis is not recommended because of the risk of developing vancomycinresistant organisms, 8,950 but vancomycin may be reserved for centers with an MRSA or MRSE cluster. 8,950,[957][958][959] No randomized controlled studies have been conducted to compare the efficacy of other antimicrobial prophylactic regimens in the prevention of early postoperative infections. For patients known to be colonized with MRSA, VRE, or resistant gramnegative pathogens, it is reasonable to consider prophylaxis specifically targeted at these organisms.…”

“…Two recent review articles noted that antimicrobial prophylaxis duration should be less than three days. 896,950 Pediatric efficacy. There are few data specifically concerning antimicrobial prophylaxis in liver transplantation in pediatric patients.…”

Complications of Kidney Transplantation: Effects of Over-Immunosuppression

“…The most common pathogens implicated in UTIs include E. coli, Staphylococci, Enterococci, Enterobacter and Pseudomonas aeruginosa [20,25]. Despite routine treatment of asymptomatic bacteriuria, patients still develop symptomatic cystitis and pyelonephritis, and recurrent asymptomatic bacteriuria has been shown to be an independent risk factor for transplant pyelonephritis [16].…”