Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (imas12), School of Medicine, Universidad Complutense, Madrid, Spain.
Curr Opin Infect Dis. 2018 Dec;31(6):499-505. doi: 10.1097/QCO.0000000000000488.
Solid organ transplantation (SOT) is the best therapeutic option for both acute and chronic end-stage diseases. The development of more potent and safer immunosuppressants and the improvement of prophylactic practices have significantly diminished the morbidity and mortality associated with rejection and opportunistic infections. However, infections produced by multidrug-resistant (MDR) Gram-negative bacilli (GNB) have recently emerged as a significant threat.
The Spanish Society of Transplantation (SET), the Group for Study of Infection in Transplantation of the Spanish Society of Infectious Diseases and Clinical Microbiology (GESITRA-SEIMC) and the Spanish Network for Research in Infectious Diseases (REIPI) have recently published their recommendations concerning the management of MDR GNB infections in SOT recipients. We review this guideline, and also the most recent available evidence, focusing on donor-derived infections, colonized recipients and therapeutic approaches.
Overall, donor and recipient colonization is associated with an increased risk of infection by MDR GNB, although none of these circumstances constitutes an absolute contraindication to transplantation. SOT recipients with risk factors for MDR GNB infection should receive an empirical treatment which includes potentially active antibiotics. Targeted therapy should be adjusted according to antimicrobial susceptibility testing and severity of infection.
实体器官移植（SOT）是治疗急性和慢性终末期疾病的最佳选择。更有效和更安全的免疫抑制剂的发展以及预防性措施的改进，显著降低了与排斥反应和机会性感染相关的发病率和死亡率。然而，最近多药耐药（MDR）革兰氏阴性菌（GNB）引起的感染已成为一个重大威胁。
西班牙移植学会（SET）、西班牙传染病学会和临床微生物学移植研究组（GESITRA-SEIMC）以及西班牙传染病研究网络（REIPI）最近发布了他们关于 SOT 受者中 MDR GNB 感染管理的建议。我们回顾了这一指南以及最新的可用证据，重点关注供体来源的感染、受者定植以及治疗方法。
总体而言，供体和受者定植与 MDR GNB 感染的风险增加相关，尽管这些情况都不构成移植的绝对禁忌。有 MDR GNB 感染风险因素的 SOT 受者应接受经验性治疗，包括具有潜在活性的抗生素。根据药敏试验和感染严重程度，应调整靶向治疗。
