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Antimicrobial stewardship in transplant patients

Hand, Jonathana; Patel, Gopib

Current Opinion in Organ Transplantation: August 2019 - Volume 24 - Issue 4 - p 497–503
doi: 10.1097/MOT.0000000000000661
INFECTIOUS DISEASES: Edited by Emily Blodget
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Purpose of review To provide an update on the current landscape of antimicrobial stewardship in solid organ transplant (SOT) recipients.

Recent findings Constructing personalized antimicrobial prescribing approaches to avoid untoward consequences of antimicrobials while improving outcomes is an emerging and critical aspect of transplant medicine. Stewardship activities encompassing the specialized interests of transplant patients and programs are evolving. New literature evaluating strategies to optimize antimicrobial agent selection, dosing, and duration have been published. Additionally, consensus guidance for certain infectious clinical syndromes is available and should inform institutional clinical practice guidelines. Novel metrics for stewardship-related outcomes in transplantation are desperately needed. Though exciting new molecular diagnostic technologies will likely be pivotal in the care of immunocompromised patients, optimal clinical adaptation and appropriate integration remains unclear. Important studies understanding the behaviors influencing antimicrobial prescribing in organizational transplant cultures are needed to optimize interventions.

Summary Consequences of antimicrobial use, such as Clostridiodes difficile and infections with multidrug-resistant organisms disproportionately affect SOT recipients and are associated with poor allograft and patient outcomes. Application of ASP interventions tailored to SOT recipients is recommended though further studies are needed to provide guidance for best practice.

aDepartment of Infectious Diseases, Ochsner Clinic Foundation, The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, Louisiana

bDivision of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA

Correspondence to Jonathan Hand, MD, 1514 Jefferson Highway, New Orleans, LA 70121, USA. Tel: +1 504 842 1191; fax: +1 504 842 5254; e-mail: Jonathan.Hand@ochsner.org

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