Bring it on: Top five antimicrobial stewardship challenges in transplant infectious diseases and practical strategies to address them

Miranda So, Helen Tsai, Neeraja Swaminathan, Rachel Bartash

Research output: Contribution to journalReview articlepeer-review

Abstract

Antimicrobial therapies are essential tools for transplant recipients who are at high risk for infectious complications. However, judicious use of antimicrobials is critical to preventing the development of antimicrobial resistance. Treatment of multidrug-resistant organisms is challenging and potentially leads to therapies with higher toxicities, intravenous access, and intensive drug monitoring for interactions. Antimicrobial stewardship programs are crucial in the prevention of antimicrobial resistance, though balancing these strategies with the need for early and frequent antibiotic therapy in these immunocompromised patients can be challenging. In this review, we summarize 5 frequently encountered transplant infectious disease stewardship challenges, and we suggest strategies to improve practices for each clinical syndrome. These 5 challenging areas are: asymptomatic bacteriuria in kidney transplant recipients, febrile neutropenia in hematopoietic stem cell transplantation, antifungal prophylaxis in liver and lung transplantation, treatment of left-ventricular assist device infections, and Clostridioides difficile infection in solid-organ and hematopoietic stem-cell transplant recipients. Common themes contributing to these challenges include limited data specific to transplant patients, shortcomings in diagnostic testing, and uncertainties in pharmacotherapy.

Original languageEnglish (US)
Article numbere72
JournalAntimicrobial Stewardship and Healthcare Epidemiology
Volume2
Issue number1
DOIs
StatePublished - Apr 27 2022

ASJC Scopus subject areas

  • Infectious Diseases
  • Epidemiology
  • Microbiology (medical)

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