Emory University School of Medicine, Atlanta, Georgia.
Icahn School of Medicine at Mount Sinai, New York, New York.
Clin Transplant. 2019 Sep;33(9):e13594. doi: 10.1111/ctr.13594. Epub 2019 Jul 22.
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of infections due to multidrug-resistant (MDR) Gram-negative bacilli in the pre- and post-transplant period. MDR Gram-negative bacilli, including carbapenem-resistant Enterobacteriaceae, MDR Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii, remain a threat to successful organ transplantation. Clinicians now have access to at least five novel agents with activity against some of these organisms, with others in the advanced stages of clinical development. No agent, however, provides universal and predictable activity against any of these pathogens, and very little is available to treat infections with MDR nonfermenting Gram-negative bacilli including A baumannii. Despite advances, empiric antibiotics should be tailored to local microbiology and targeted regimens should be tailored to susceptibilities. Source control remains an important part of the therapeutic armamentarium. Morbidity and mortality associated with infections due to MDR Gram-negative organisms remain unacceptably high. Heightened infection control and antimicrobial stewardship initiatives are needed to prevent these infections, curtail their transmission, and limit the evolution of MDR Gram-negative pathogens, especially in the setting of organ transplantation.
这些由美国移植学会传染病实践社区更新的指南回顾了器官移植前和移植后耐多药（MDR）革兰氏阴性菌感染的诊断、预防和管理。耐多药革兰氏阴性菌，包括耐碳青霉烯类肠杆菌科细菌、耐多药铜绿假单胞菌和耐碳青霉烯类鲍曼不动杆菌，仍然是成功进行器官移植的威胁。临床医生现在至少有五种新型药物可用于治疗其中一些病原体，还有其他药物处于临床开发的后期阶段。然而，没有一种药物对这些病原体具有普遍且可预测的活性，而且几乎没有药物可用于治疗耐多药非发酵革兰氏阴性菌引起的感染，包括鲍曼不动杆菌。尽管取得了进展，但经验性抗生素应根据当地微生物学进行调整，靶向治疗方案应根据药敏试验进行调整。源头控制仍然是治疗手段的重要组成部分。耐多药革兰氏阴性菌感染相关的发病率和死亡率仍然高得令人无法接受。需要加强感染控制和抗菌药物管理计划，以预防这些感染，遏制其传播，并限制耐多药革兰氏阴性病原体的进化，特别是在器官移植的情况下。
