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Serris A, Coussement J, Pilmis B, De Lastours V, Dinh A, Parquin F, Epailly E, Ader F, Lortholary O, Morelon E, Kamar N, Forcade E, Lebeaux D, Dumortier J, Conti F, Lefort A, Scemla A, Kaminski H. New Approaches to Manage Infections in Transplant Recipients: Report From the 2023 GTI (Infection and Transplantation Group) Annual Meeting. Transpl Int 2023; 36:11859. [PMID: 38020750 PMCID: PMC10665482 DOI: 10.3389/ti.2023.11859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Alexandra Serris
- Department of Infectious Diseases, Necker-Enfants Malades University Hospital, Paris, France
| | - Julien Coussement
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Benoît Pilmis
- Equipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
- Institut Micalis UMR 1319, Université Paris-Saclay, Institut National de Recherche Pour l’agriculture, l’alimentation et l’environnement, AgroParisTech, Jouy-en-Josas, France
| | - Victoire De Lastours
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, Hôpital Universitaire Beaujon, Clichy, France
| | - Aurélien Dinh
- Infectious Disease Department, Raymond-Poincaré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris Saclay University, Garches, France
| | - François Parquin
- Service de Chirurgie Thoracique et Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | - Eric Epailly
- Department of Cardiology and Cardiovascular Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Florence Ader
- Infectious Diseases Department, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Olivier Lortholary
- Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France
| | - Emmanuel Morelon
- Department of Transplantation, Edouard Herriot University Hospital, Hospices Civils de Lyon, University Lyon, University of Lyon I, Lyon, France
| | - Nassim Kamar
- Nephrology and Organ Transplantation Unit, Centre Hospitalo Universitraire Rangueil, INSERM U1043, Structure Fédérative de Recherche Bio-Médicale de Toulouse, Paul Sabatier University, Toulouse, France
| | - Edouard Forcade
- Service d'Hématologie Clinique et Thérapie Cellulaire, Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut Lévêque, Bordeaux, France
| | - David Lebeaux
- Service de Microbiologie, Unité Mobile d'Infectiologie, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, et Université Claude Bernard Lyon 1, Lyon, France
| | - Filomena Conti
- Assistance Publique-Hôpitaux de Paris (Assistance Publique - Hôpitaux de Paris), Pitié-Salpêtrière Hospital, Department of Medical Liver Transplantation, Paris, France
| | - Agnes Lefort
- IAME, Infection Antimicrobials Modelling Evolution, UMR1137, Université Paris-Cité, Paris, France
- Department of Internal Medicine, Beaujon University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Anne Scemla
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hannah Kaminski
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France
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So M, Tsai H, Swaminathan N, Bartash R. Bring it on: Top five antimicrobial stewardship challenges in transplant infectious diseases and practical strategies to address them. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e72. [PMID: 36483373 PMCID: PMC9726551 DOI: 10.1017/ash.2022.53] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 06/17/2023]
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.
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Affiliation(s)
- Miranda So
- Sinai Health-University Health Network Antimicrobial Stewardship Program, University Health Network, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Helen Tsai
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Neeraja Swaminathan
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Rachel Bartash
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
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