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

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 recommendation...

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Detalles Bibliográficos
Autores: Aguado García, José María, Silva, J.T., Fernández Ruiz, M., Cordero, E., Fortún, J., Gudiol, C., Martínez Martínez, L., Vidal, E., Almenar, L., Almirante, B., Cantón, R., Carratalá Fernández, Jordi, Caston, J.J., Cercenado, E., Cervera, C., Cisneros, J.M., Crespo Leiro, M.G., Cuervas Mons, V., Elizalde Fernández, J., Fariñas Álvarez, María del Carmen
Tipo de recurso: artículo
Fecha de publicación:2017
País:España
Institución:Universidad de Cantabria (UC)
Repositorio:UCrea Repositorio Abierto de la Universidad de Cantabria
Idioma:inglés
OAI Identifier:oai:repositorio.unican.es:10902/11528
Acceso en línea:http://hdl.handle.net/10902/11528
Access Level:acceso abierto
Palabra clave:Solid organ transplantation
Multidrug resistant Gram-negative bacilli
Extended-spectrum β-lactamases
Carbapenem-resistant Gram-negative bacilli
Descripción
Sumario: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.

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