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Current Infectious Disease Reports

Erschienen in:

01.07.2019 | Transplant and Oncology (M Ison, N Theodoropoulos and S Pergam, Section Editors)

Carbapenem-Resistant Enterobacteriaceae in Solid Organ Transplantation: Management Principles

verfasst von: Olivia Smibert, Michael J. Satlin, Anoma Nellore, Anton Y. Peleg

Erschienen in: Current Infectious Disease Reports | Ausgabe 7/2019

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Abstract

Purpose of Review

Carbapenem-resistant Enterobacteriaceae (CRE) have emerged as a worldwide problem. Given their degree of immunosuppression and the level of contact with the healthcare system, solid organ transplant (SOT) recipients are at a disproportionately higher risk of acquisition, colonization, and infection with CRE, and outcomes from infection tend to be worse compared to non-transplant patients. Therapeutic options are limited for CRE infections although several newer agents have recently been approved for use. How well these agents perform in the setting of immunosuppression and SOT is unclear. We sought to review the epidemiology of CRE in SOT and the management principles.

Recent Findings

CRE infections are becoming an increasing problem in SOT, and donor-derived infections present a challenge in the peri-transplant period. Newer treatments for CRE are emerging that are less toxic and potentially more effective than prior CRE-active agents, but supportive clinical data are limited. Newer beta-lactamase inhibitors have good activity against KPC carbapenemases, but they lack activity against metallo-beta-lactamases (e.g., NDM). Promising data is emerging with newer agents that have activity against most carbapenemases, but, again, clinical data is needed. Combination therapy in addition to optimal pharmacokinetic and pharmacodynamics may go some way to improve outcomes against these difficult-to-treat organisms. Other novel therapies that prevent the emergence of resistance (oral beta-lactamase inhibitors) and eradication of resistant Gram-negative colonization (fecal microbiota transplant) may eventually become part of a bundle approach to reduce CRE infections in the future.

Summary

As in non-transplant patients, CRE infections in the transplant setting are challenging to treat and prevent. Infection prevention and control remains crucial to prevent widespread dissemination, and unique challenges exist with donor-derived CRE and how best to manage recipients in the peri-transplant period. Newer treatments are now in early-phase clinical studies, and in vitro activity data are supportive for several agents providing hope for improved outcomes with these typically difficult-to-treat and highly morbid infections in transplant recipients.

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Titel: Carbapenem-Resistant Enterobacteriaceae in Solid Organ Transplantation: Management Principles
verfasst von: Olivia Smibert
Michael J. Satlin
Anoma Nellore
Anton Y. Peleg
Publikationsdatum: 01.07.2019
Verlag: Springer US
Erschienen in: Current Infectious Disease Reports / Ausgabe 7/2019
Print ISSN: 1523-3847
Elektronische ISSN: 1534-3146
DOI: https://doi.org/10.1007/s11908-019-0679-4

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Carbapenem-Resistant Enterobacteriaceae in Solid Organ Transplantation: Management Principles

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