Survey on the approach to antibiotic prophylaxis in liver and kidney transplant recipients colonized with "difficult to treat" Gram-negative bacteria

• Published in: Transplant infectious disease 2024-04, Vol.26 (2), p.e14238-e14238
• Main Authors: Bonazzetti, Cecilia, Rinaldi, Matteo, Cosentino, Federica, Gatti, Milo, Freire, Maristela Pinheiro, Mularoni, Alessandra, Clemente, Wanessa Trindade, Pierrotti, Ligia Camera, Aguado, Jose Maria, Grossi, Paolo, Pea, Federico, Viale, Pierluigi, Giannella, Maddalena
• Format: Article
• Language: English
• Subjects: Antibiotics; Bacteria; Carbapenems; Cephalosporins; Colonization; Disease prevention; Enterobacterales; Gram-negative bacteria; Heterogeneity; Infections; Infectious diseases; Kidney transplantation; Liver; Liver transplantation; Multidrug resistance; Patients; Prophylaxis; Surveys; Transplants & implants
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.14238

Performance of active screening for multidrug-resistant Gram-negative bacteria (MDR-GNB) and administration of targeted antibiotic prophylaxis (TAP) in colonized patients undergoing liver (LT) and/or kidney transplantation (KT) are controversial issues. Self-administered electronic cross-sectional survey disseminated from January to February 2022. Questionnaire consisted of four parts: hospital/transplant program characteristics, standard screening and antibiotic prophylaxis, clinical vignettes asking for TAP in patients undergoing LT and KT with prior infection/colonization with four different MDR-GNB (extended-spectrum cephalosporin-resistant Enterobacterales [ESCR-E], carbapenem-resistant Enterobacterales [CRE], multidrug-resistant Pseudomonas aeruginosa [MDR-Pa], and carbapenem-resistant Acinetobacter baumannii [CRAb]). Fifty-five respondents participated from 14 countries, mostly infectious disease specialists (69%) with active transplant programs (>100 procedures/year for 34.5% KT and 23.6% LT), and heterogeneous local MDR-GNB prevalence from 30% (16.4%). The frequency of screening for ESCR-E, CRE, MDR-Pa, and CRAb was 22%, 54%, 17%, and 24% for LT, respectively, and 18%, 36%, 16%, and 11% for KT. Screening time-points were mainly at transplantation 100%, only one-third following transplantation. Screening was always based on rectal swab cultures (100%); multi-site sampling was reported in 40% of KT and 35% of LT. In LT clinical cases, 84%, 58%, 84%, and 40% of respondents reported TAP for prior infection/colonization with ESCR-E, CRE, MDR-Pa, and CRAb, respectively. In KT clinical cases, 55%, 39%, 87%, and 42% of respondents reported TAP use for prior infection/colonization with ESCR-E, CRE, MDR-Pa, and CRAb, respectively. There is a large heterogeneity in screening and management of MDR-GNB carriage in LT and KT.