Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece.
Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Transpl Infect Dis. 2022 Oct;24(5):e13852. doi: 10.1111/tid.13852.
In the last decades, solid organ transplantation (SOT) has emerged as an important method in the management of chronic kidney, liver, heart, and lung failure. Antimicrobial use has led to a significant reduction of morbidity and mortality due to infectious complications among patients with SOT; however, it can lead to adverse events and drive the development of antimicrobial resistance; thus, antimicrobial stewardship is of extreme importance. Even though there are ongoing efforts of transplant societies to implement principles of antimicrobial stewardship in everyday practice in SOT, there is still a lack of guidelines in this patient population.
The aim of this study was to review the status of antimicrobial stewardship in patients with SOT, highlight its importance from the perspective of an ongoing vivid dialogue among ESCMID experts in the field of antimicrobial stewardship, and depict opportunities for future study in the field.
Antimicrobial stewardship programs are important in order to allow appropriate initiation and termination of antimicrobials in SOT recipients, and also aid in the most appropriate dosing and choosing of the route of administration of antimicrobials. Application of already known antimicrobial stewardship principles and application of currently used biomarkers and newly developed molecular rapid diagnostic testing tools can aid to the rationalization of antimicrobial prescribing and to a more targeted treatment of infections. Finally, physicians caring for SOT recipients should be actively involved in antimicrobial stewardship in order to assure optimization of antimicrobial prescribing and become familiar with the principles of antimicrobial stewardship.
在过去的几十年中，实体器官移植（SOT）已成为治疗慢性肾功能、肝功能、心功能和肺功能衰竭的重要方法。抗菌药物的使用显著降低了 SOT 患者因感染并发症而导致的发病率和死亡率；然而，它也可能导致不良事件并促使抗菌药物耐药性的发展；因此，抗菌药物管理至关重要。尽管移植学会一直在努力将抗菌药物管理原则纳入 SOT 日常实践中，但该患者群体仍缺乏相关指南。
本研究旨在回顾 SOT 患者的抗菌药物管理现状，从抗菌药物管理领域 ESCMID 专家正在进行的生动对话的角度强调其重要性，并描绘该领域未来研究的机会。
抗菌药物管理计划对于允许 SOT 受者适当开始和停止使用抗菌药物以及辅助最适当的剂量和选择抗菌药物的给药途径非常重要。应用已知的抗菌药物管理原则和目前使用的生物标志物以及新开发的分子快速诊断检测工具，有助于合理使用抗菌药物，并更有针对性地治疗感染。最后，照顾 SOT 受者的医生应积极参与抗菌药物管理，以确保优化抗菌药物的使用，并熟悉抗菌药物管理原则。
