Gopi Patel1, Federico Perez, Robert A Bonomo. 1. aDepartment of Medicine, Mount Sinai School of Medicine, New York, New York, USA bResearch Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, USA cDivision of Infectious Diseases and HIV Medicine, University Hospitals Case Medical Center, USA dDepartment of Medicine, Case Western Reserve School of Medicine, USA eDepartment of Molecular Biology and Microbiology, Case Western Reserve School of Medicine, USA fDepartment of Pharmacology, Case Western Reserve School of Medicine, Cleveland, Ohio, USA.
Abstract
PURPOSE OF REVIEW: This review highlights the impact of carbapenem-resistant Enterobacteriaceae and carbapenem-resistant Acinetobacter baumannii on patients who have undergone organ transplantation and explores both available and potential agents to treat infections caused by these multidrug-resistant (MDR) pathogens. RECENT FINDINGS: Few antimicrobials exist to treat carbapenem-resistant Gram-negative infections, and resistance to salvage therapies is escalating. Organ transplantation appears to be a risk factor for infections with Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Isolation of these MDR bacteria is increasing and may be associated with allograft failure and mortality. In the majority of cases, aminoglycosides, polymyxins, and tigecycline have been employed to treat these infections. Anecdotal successes exist but these antibiotics may be unreliable. Few novel agents are in development. SUMMARY: Bacterial infections remain a leading cause of posttransplantation morbidity and mortality. Carbapenem resistance is a significant threat to allograft and patient survival. With few antimicrobials being developed, transplant centers may be forced to make decisions regarding surveillance, empiric antimicrobial regimens, and transplant candidacy in the setting of carriage of MDR pathogens. There is an urgent need for collaborative studies to address the clinical impact of these infections on transplantation.
PURPOSE OF REVIEW: This review highlights the impact of carbapenem-resistant Enterobacteriaceae and carbapenem-resistant Acinetobacter baumannii on patients who have undergone organ transplantation and explores both available and potential agents to treat infections caused by these multidrug-resistant (MDR) pathogens. RECENT FINDINGS: Few antimicrobials exist to treat carbapenem-resistant Gram-negative infections, and resistance to salvage therapies is escalating. Organ transplantation appears to be a risk factor for infections with Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Isolation of these MDR bacteria is increasing and may be associated with allograft failure and mortality. In the majority of cases, aminoglycosides, polymyxins, and tigecycline have been employed to treat these infections. Anecdotal successes exist but these antibiotics may be unreliable. Few novel agents are in development. SUMMARY: Bacterial infections remain a leading cause of posttransplantation morbidity and mortality. Carbapenem resistance is a significant threat to allograft and patient survival. With few antimicrobials being developed, transplant centers may be forced to make decisions regarding surveillance, empiric antimicrobial regimens, and transplant candidacy in the setting of carriage of MDR pathogens. There is an urgent need for collaborative studies to address the clinical impact of these infections on transplantation.
Authors: C J Clancy; L Chen; R K Shields; Y Zhao; S Cheng; K D Chavda; B Hao; J H Hong; Y Doi; E J Kwak; F P Silveira; R Abdel-Massih; T Bogdanovich; A Humar; D S Perlin; B N Kreiswirth; M Hong Nguyen Journal: Am J Transplant Date: 2013-09-06 Impact factor: 8.086
Authors: Vladislav Dolgachev; Sreehari Panicker; Sanjay Balijepalli; Lane Kelly McCandless; Yue Yin; Samantha Swamy; M V Suresh; Matthew J Delano; Mark R Hemmila; Krishnan Raghavendran; David Machado-Aranda Journal: Gene Ther Date: 2018-06-15 Impact factor: 5.250