Not Just an Oxymoron: The Utilitarian's Guide to Antimicrobial Stewardship in Transplant Infectious Diseases.

IF 2.6 4区医学 Q3 IMMUNOLOGY Transplant Infectious Disease Pub Date : 2024-11-25 DOI:10.1111/tid.14399

Chelsea A Gorsline, Divisha Sharma, Courtney E Harris, Jonathan Hand, Hannah Imlay, Erica J Stohs, Miranda So, Rebecca N Kumar

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Abstract

Solid organ transplant and hematopoietic cell transplant patients face an increased risk of infectious diseases, greater exposure to antibiotics, and heightened risk of multidrug-resistant organisms (MDROs) due to their immunosuppressed state. Antimicrobial stewardship programs (ASP) are essential in reducing the incidence of MDRO by conserving antimicrobial use, minimizing treatment durations, and improving the appropriate use of diagnostic testing. However, the role of ASP in transplant infectious diseases (TID) is still evolving, necessitating greater collaboration between ASP and transplant programs. This collaboration will mitigate infection risks, reduce infection-associated costs, and improve outcomes. This article reviews the key components for implementing ASP in TID, especially for those that are establishing or growing their ASP to include TID, including specific goals, structure and funding, ASP initiatives (including antibiotic allergy delabeling, diagnostic stewardship, and antiviral/antifungal stewardship), metrics, and educational opportunities.

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不只是一个 "牛魔王"：移植感染性疾病中抗菌药物管理的功利主义指南》。

实体器官移植和造血细胞移植患者由于处于免疫抑制状态，感染传染病的风险增加，接触抗生素的机会增多，耐多药生物体（MDRO）的风险增大。抗菌药物管理计划（ASP）通过节约抗菌药物的使用、缩短治疗时间和改进诊断检测的合理使用，对降低 MDRO 的发病率至关重要。然而，ASP 在移植感染性疾病（TID）中的作用仍在不断发展，因此有必要加强 ASP 与移植项目之间的合作。这种合作将降低感染风险、减少感染相关费用并改善治疗效果。本文回顾了在 TID 中实施 ASP 的关键要素，尤其是那些正在建立或发展 ASP 以纳入 TID 的项目，包括具体目标、结构和资金、ASP 计划（包括抗生素过敏标签、诊断监管和抗病毒/抗真菌监管）、衡量标准和教育机会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.