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Transplant Rev (Orlando). 2018 Jan;32(1):36-57. doi: 10.1016/j.trre.2017.07.001. Epub 2017 Jul 26.

Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations.

Author information

1
Unit of Infectious Diseases, Instituto de Investigación Hospital "12 de Octubre" (i+12), University Hospital "12 de Octubre", Universidad Complutense, Madrid, Spain. Electronic address: jaguadog1@gmail.com.
2
Department of Infectious Diseases, University Hospital of Badajoz, Fundación para la Formación e Investigación de los Profesionales de la Salud de Extremadura (FundeSalud), Universidad de Extremadura, Badajoz, Spain.
3
Unit of Infectious Diseases, Instituto de Investigación Hospital "12 de Octubre" (i+12), University Hospital "12 de Octubre", Universidad Complutense, Madrid, Spain.
4
Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío, CSIC, University of Seville, Spain.
5
Department of Infectious Diseases, University Hospital Ramón y Cajal, Madrid, Spain.
6
Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain.
7
Clinical Unit of Microbiology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Spain.
8
Clinical Unit of Infectious Diseases, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Spain.
9
Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital Universitario La Fe, Valencia, Spain.
10
Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
11
Microbiology Department, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
12
Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
13
Department of Medicine, Division of Infectious Diseases, University of Alberta, Edmonton, Canada.
14
Cardiology Department, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain.
15
Liver Transplantation, Internal Medicine, Hospital Clínica Puerta de Hierro, Madrid, Spain.
16
Intensive Care Unit, Hospital de Navarra, Pamplona, Spain.
17
Unit of Infectious Diseases, University Hospital Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
18
Clinical Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla, IBiS-Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Universidad de Sevilla, Sevilla, Spain.
19
Department of Nephrology, Carlos Haya Regional University Hospital, Institute of Biomedical Research in Malaga (IBIMA), University of Malaga, Malaga, Spain.
20
Hepatobiliopancreatic Surgery and Transplantation Unit, General Surgery Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
21
Unit of Infectious Diseases, University Hospital de Cruces, Bilbao, Spain.
22
Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
23
Department of Microbiology and Research Unit, Hospital Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, Spain.
24
Lung Transplant Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
25
Nephrology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
26
Lung Transplant Unit, Department of Pneumology, Hospital Universitario La Fe, Valencia, Spain.
27
Clinical Unit of Infectious Diseases, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Spain. Electronic address: julian.torre@sspa.juntadeandalucia.es.

Abstract

Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate's phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.

PMID:
28811074
DOI:
10.1016/j.trre.2017.07.001
[Indexed for MEDLINE]

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