Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA.
Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Expert Rev Anti Infect Ther. 2024 Oct;22(10):855-866. doi: 10.1080/14787210.2024.2399647. Epub 2024 Sep 5.
Cytomegalovirus (CMV) is a classic opportunistic infection in transplant recipients. Treatment-refractory CMV infections are of concern, with growing identification of strains that have developed genetic mutations which confer resistance to standard antiviral therapy. Resistant and refractory CMV infections are associated with worse patient outcomes, prolonged hospitalization, and increased healthcare costs.
This article provides a comprehensive practical overview of resistant and refractory CMV infections in transplant recipients. We review the updated definitions for these infections, antiviral pharmacology, mechanisms of drug resistance, diagnostic workup, management strategies, and host-related factors including immune optimization.
Resistant and refractory CMV infections are a significant contributor to post-transplant morbidity and mortality. This is likely the result of a combination of prolonged antiviral exposure and active viral replication in the setting of intensive pharmacologic immunosuppression. Successful control of resistant and refractory infections in transplant recipients requires a combination of immunomodulatory optimization and appropriate antiviral drug choice with sufficient treatment duration.
巨细胞病毒（CMV）是移植受者中一种经典的机会性感染。治疗耐药的 CMV 感染令人担忧，越来越多的研究发现，一些菌株发生了基因突变，从而对标准抗病毒治疗产生了耐药性。耐药和难治性 CMV 感染与患者预后较差、住院时间延长和医疗费用增加有关。
本文对移植受者中耐药和难治性 CMV 感染进行了全面的综述。我们回顾了这些感染的最新定义、抗病毒药理学、耐药机制、诊断方法、管理策略以及包括免疫优化在内的宿主相关因素。
耐药和难治性 CMV 感染是移植后发病率和死亡率的重要原因。这可能是由于长期抗病毒暴露和在强化药物免疫抑制的情况下病毒的持续复制共同作用的结果。成功控制移植受者中的耐药和难治性感染需要结合免疫调节优化和适当的抗病毒药物选择，以及足够的治疗持续时间。
