1. Survey on the approach to antibiotic prophylaxis in liver and kidney transplant recipients colonized with "difficult to treat" Gram-negative bacteria.
- Author
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Bonazzetti C, Rinaldi M, Cosentino F, Gatti M, Freire MP, Mularoni A, Clemente WT, Pierrotti LC, Aguado JM, Grossi P, Pea F, Viale P, and Giannella M
- Subjects
- Humans, Antibiotic Prophylaxis, Cross-Sectional Studies, Gram-Negative Bacteria, Anti-Bacterial Agents therapeutic use, Anti-Bacterial Agents pharmacology, Drug Resistance, Multiple, Bacterial, Liver, Carbapenems, Surveys and Questionnaires, Gram-Negative Bacterial Infections diagnosis, Gram-Negative Bacterial Infections drug therapy, Gram-Negative Bacterial Infections prevention & control, Kidney Transplantation adverse effects
- Abstract
Background: 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., Methods: 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])., Results: 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 <15% (30.9%), 15%-30% (43.6%) to >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., Conclusion: There is a large heterogeneity in screening and management of MDR-GNB carriage in LT and KT., (© 2024 Wiley Periodicals LLC.)
- Published
- 2024
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