[Current status and future prospects of antibacterial treatment for Carbapenem-resistant gram-negative bacterial infections in solid organ transplant recipients].

In recent years, infections caused by carbapenem-resistant Gram-negative bacteria (CR-GNB) and other multidrug-resistant (MDR) pathogens have posed significant challenges in solid organ transplantation (SOT). SOT recipients who develop CR-GNB infections face risks such as graft loss, respiratory failure, leading to a mortality rate exceeding 40%. This review examines the current resistance landscape and the characteristics of MDR infections in SOT recipients, discussing the epidemiological features of CR-GNB infections in SOT patients, the resistance profiles and mechanisms of common CR-GNB (e.g., Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa), and evidence-based principles and strategies for antimicrobial therapy. The article provides an in-depth analysis of the efficacy, pharmacokinetic/pharmacodynamic (PK/PD) properties, and adverse effects of both commonly used antibiotics (such as tigecycline, polymyxins, and ceftazidime/avibactam) and the novel agents (including eravacycline and sulbactam/durlobactam), emphasizing the importance of combination therapy and personalized treatment approaches. Additionally, it explores the clinical potential of emerging rapid diagnostic technologies (e.g., CRISPR/Cas systems, mass spectrometry) and innovative treatments such as phage therapy and immunomodulation. Looking ahead, the review envisions a future where, guided by rapid and precise diagnostics, multidisciplinary management can optimize antimicrobial regimens for MDR infections in transplant recipients. The goal is to achieve individualized, effective treatment strategies, thereby improving outcomes in severe infections and advancing the management of CR-GNB infections in SOT patients in China.