Universal Multiplex Panel Testing of Donor Lungs as a Strategy to Optimize Antibiotic Prophylaxis Against Multidrug-Resistant Bacteria.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2025-02-17 DOI:10.1111/tid.14446

Rayid Abdulqawi, Rana A Saleh, Reem M Alameer, Roaa Alabiri, Ruba Alabiri, Khaled Alkattan, Reem S Almaghrabi, Zainab Al Duhailib, Sahar Althawadi, Najib M Rahman, Waleed Saleh, Amani H Yamani, Eid A Al-Mutairy

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引用次数: 0

Abstract

Background: Twenty percent of lung donors in our transplant program carry respiratory carbapenem-resistant (CR) gram-negative bacteria (GNB), most commonly CR Acinetobacter baumannii. Universal multiplex panel testing of lung transplant donors was introduced in June 2022 as a strategy to expedite CR-GNB detection and optimize perioperative antibiotic prophylaxis. We herein describe our experiences with this approach.

Methods: Retrospective single-center cohort study including 53 adult patients who underwent lung-only transplantation between June 2022 and December 2023.

Results: The most common bacteria identified by the multiplex panel were Staphylococcus aureus (n = 20), A. baumannii (n = 13), Klebsiella pneumoniae (n = 13), and Pseudomonas aeruginosa (n = 10). The panel detected 6/9 A. baumannii, 2/2 CR K. pneumoniae, 1/1 CR P. aeruginosa, and 7/8 methicillin-resistant S. aureus that were grown on conventional cultures, corresponding to negative predictive values of 94%, 100%, 100%, and 98%. Based on panel or culture results, IV tigecycline was administered as prophylaxis in 19% of patients, colistin in 17%, and novel beta-lactams in 15%.

Conclusion: The multiplex panel rapidly detected donor CR-GNB with a high negative predictive value and resulted in clinical effects of reducing broad-spectrum antibiotic prescriptions and maintaining adequate posttransplant outcomes. Prospective studies with predefined outcomes are needed to compare panel-directed therapy against current standards of care.

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背景：在我们的移植项目中，20%的肺移植供体携带呼吸道耐碳青霉烯类（CR）革兰氏阴性菌（GNB），最常见的是CR鲍曼不动杆菌。2022 年 6 月，我们开始对肺移植供体进行通用多重面板检测，以此加快 CR-GNB 的检测速度并优化围手术期抗生素预防。我们在此介绍我们在这方面的经验：方法：回顾性单中心队列研究，包括在 2022 年 6 月至 2023 年 12 月期间接受纯肺移植的 53 名成年患者：结果：多重鉴定小组鉴定出的最常见细菌为金黄色葡萄球菌（n = 20）、鲍曼不动杆菌（n = 13）、肺炎克雷伯菌（n = 13）和铜绿假单胞菌（n = 10）。该检测板检测出 6/9 例鲍曼不动杆菌、2/2 例 CR 肺炎克雷伯菌、1/1 例 CR 铜绿假单胞菌和 7/8 例在常规培养中生长的耐甲氧西林金黄色葡萄球菌，其阴性预测值分别为 94%、100%、100% 和 98%。根据检测组或培养结果，19% 的患者使用了替加环素静脉注射预防，17% 的患者使用了可乐定，15% 的患者使用了新型β-内酰胺类药物：多重检测面板能快速检测出供体的 CR-GNB，并具有较高的阴性预测值，其临床效果是减少了广谱抗生素的处方量，并保持了适当的移植后疗效。需要进行具有预定义结果的前瞻性研究，以将面板指导疗法与当前的护理标准进行比较。

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.