So Miranda, Walti Laura
Toronto General Hospital, University Health Network, 9th Floor Munk Building, Room 800, 585 University Avenue, Toronto, ON M5G 2N2 Canada.
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Canada.
Curr Infect Dis Rep. 2022;24(5):63-75. doi: 10.1007/s11908-022-00778-1. Epub 2022 Apr 30.
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.
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 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 and commonly cause bacteremia and intra-abdominal infections in liver and kidney recipients. Carbapenemase-producing Enterobacterales, mainly , are responsible for infections early-post transplant in liver, lung, kidney, and heart recipients. and 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.
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.
如果没有有效的抗菌药物，患者就无法安全地接受移植手术或维持免疫抑制治疗。本综述探讨了实体器官移植受者中抗菌药物耐药性的负担，并确定了抗菌药物管理的机会。
抗菌药物耐药性已被确定为全球主要死因。多重耐药病原体与移植受者的高发病率和死亡率相关。耐甲氧西林金黄色葡萄球菌影响肝脏和肺部移植受者，可导致菌血症、肺炎和手术部位感染。耐万古霉素肠球菌是一种医院病原体，主要导致肝脏移植受者发生菌血症。多重耐药革兰氏阴性病原体对移植受者构成紧迫而严重的威胁。产超广谱β-内酰胺酶的大肠埃希菌和肺炎克雷伯菌通常在肝脏和肾脏移植受者中引起菌血症和腹腔内感染。产碳青霉烯酶肠杆菌科细菌，主要是肺炎克雷伯菌，是肝脏、肺部、肾脏和心脏移植受者移植后早期感染的原因。鲍曼不动杆菌和铜绿假单胞菌仍然是严重威胁。虽然有针对耐药病原体的新型抗菌药物，但明智地开药对于尽量减少新出现的耐药性至关重要。2019冠状病毒病全球大流行对移植受者抗菌药物耐药性的全面影响仍有待了解。目前，抗菌药物管理干预措施的实施尚无既定标准，但利用现有抗菌药物管理计划结构并根据移植受者需求进行调整的策略可能有助于优化抗菌药物的使用。
照顾移植受者的临床医生在应对新出现的抗菌药物耐药性方面面临独特挑战。与移植和传染病方面的适当专业知识合作进行协调的抗菌药物管理干预措施可能会减轻此类威胁。
