title: Multidrug-resistant bacterial infections after liver transplantation: an ever-growing challenge.
abstract: Bacterial infections are a leading cause of morbidity and mortality among solid organ transplant recipients. Over the last two decades, various multidrug-resistant (MDR) pathogens have emerged as relevant causes of infection in this population. Although this fact reflects the spread of MDR pathogens in health care facilities worldwide, several factors relating to the care of transplant donor candidates and recipients render these patients particularly prone to the acquisition of MDR bacteria and increase the likelihood of MDR infectious outbreaks in transplant units. The awareness of this high vulnerability of transplant recipients to infection leads to the more frequent use of broad-spectrum empiric antibiotic therapy, which further contributes to the selection of drug resistance. This vicious cycle is difficult to avoid and leads to a scenario of increased complexity and narrowed therapeutic options. Infection by MDR pathogens is more frequently associated with a failure to start appropriate empiric antimicrobial therapy. The lack of appropriate treatment may contribute to the high mortality occurring in transplant recipients with MDR infections. Furthermore, high therapeutic failure rates have been observed in patients infected with extensively-resistant pathogens, such as carbapenem-resistant Enterobacteriaceae, for which optimal treatment remains undefined. In such a context, the careful implementation of preventive strategies is of utmost importance to minimize the negative impact that MDR infections may have on the outcome of liver transplant recipients. This article reviews the current literature regarding the incidence and outcome of MDR infections in liver transplant recipients, and summarizes current preventive and therapeutic recommendations.
authors.affiliation: Guilherme Santoro-Lopes, Erika Ferraz de Gouvêa, Infectious Diseases Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ-CEP 21941-913, Brazil.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Santoro-Lopes
authors.affiliation: Guilherme Santoro-Lopes, Erika Ferraz de Gouvêa, Infectious Diseases Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ-CEP 21941-913, Brazil.
authors.forename: Erika Ferraz
authors.initials: EF
authors.lastname: de Gouvêa
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications* / Q000188:drug therapy*; D001426:Bacterial Proteins / Q000378:metabolism; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000378:metabolism; D016983:Enterococcus / Q000187:drug effects; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D008826:Microbial Sensitivity Tests; D011550:Pseudomonas aeruginosa / Q000378:metabolism; D012307:Risk Factors; D014640:Vancomycin / Q000737:chemistry; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D014640:Vancomycin; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Bacterial infections; Liver transplantation; Methicillin-resistant Staphylococcus aureus; Multidrug resistance; Organ transplantation