AUTHOR=Freire Maristela Pinheiro , Pouch Stephanie , Manesh Abi , Giannella Maddalena 

TITLE=Burden and Management of Multi-Drug Resistant Organism Infections in Solid Organ Transplant Recipients Across the World: A Narrative Review

JOURNAL=Transplant International

VOLUME=Volume 37 - 2024

YEAR=2024

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2024.12469

DOI=10.3389/ti.2024.12469

ISSN=1432-2277

ABSTRACT=Solid organ transplant (SOT) recipients are particularly susceptible to infections caused by multidrug-resistant organisms (MDRO) and are often the first to be affected by an emerging agent or resistant pathogen. Among MDROs, those with the most extensively documented epidemiology and associated risk factors are Enterobacterales resistant to carbapenems (CRE) and extended-spectrum cephalosporins (ESCR-E). The prevalence of CRE appears to be higher in high-income countries (HIC) at 6% (range 1.9-10.3%), compared to low-and middle-income countries (LMIC) at 4.0% (range 0.9-15.7%).Conversely, ESCR-E seems to be more frequent in LMIC at 7.0% (range 4.4-11.2%).Additionally, difficult-to-treat resistant Pseudomonas (DTR-Pa) infections after SOT seem to be more common in HIC at 7%, whereas carbapenem-resistant Acinetobacter baumannii (CRAB) is more commonly reported in LMIC at 4.1% (range 0.8-28.6%). The published low resistance rates in the LMICs may be confounded by reporting bias. It is critical in this population to initiate effective therapy as soon as possible. Therefore, the use of rapid tests along with additional investigation of resistance mechanisms and expanded sensitivity testing for antimicrobials are desirable. Therapeutic options for MDROs are limited, especially for DTR-Pa and CRAB, in this context, the article proposes a treatment flowchart based on species and resistance mechanisms.