Transplant Gets in the Stewardship Game: Duration of Antibiotics and Organ Utilization

Reviewed by Hannah Imlay, MD MS; University of Utah Health, Salt Lake City, UT and Erica Stohs, MD MPH; University of Nebraska Medical Center, Omaha, NE

Two recent studies have broadened how we approach antibiotic durations and contextualize donor multidrug-resistant organisms (MDROs) in organ transplant recipients.

The first study addressed shorter versus longer duration of antibiotics among kidney transplant recipients for urinary tract infections (UTI). Many guidelines still cite 14-21 days as duration for allograft pyelonephritis – however a retrospective cohort of short vs long durations in kidney recipients showed that outcomes with a shorter duration of antibiotics (6-10 days) was similar to longer durations (11-21 days). No differences in primary outcomes were found: a composite outcome of all-cause mortality or readmission within 30 days occurred in 30% (long) vs 28.6% (short) of patients and relapse of UTI within 180 days occurred in 21% (long) vs 16% (short). A separate analysis was done among the 93 patients within the first 6 months post-transplant (43 short, 50 long). There were no differences in outcomes between groups, although a higher overall rate of mortality/readmission in this subgroup (38%). These data suggest that antibiotic duration of <10 days may be appropriate for kidney transplant recipients >1 month post-transplant with complicated UTI.

In a second retrospective observational cohort study in 3 Pennsylvania hospitals, authors evaluated if donor cultures with MDROs were associated with development of an invasive bacterial or candida infection within 3 months post-transplant and graft failure or death within 12 months of transplant. The study evaluated 658 transplant recipients who were divided into 3 cohorts: those with donor cultures with MRDOs, donor cultures with non-MDROs, and negative or contaminated donor cultures. In multivariate analyses, the authors found that donor MDROs were associated with significantly increased hazard of infection compared with those with negative donor cultures (aHR 1.63, CI 1.01-2.62, p=0.04). There was no association with graft failure or death 12 months post-transplant.

References :

Avni-Nachman S, et al. Short versus prolonged antibiotic treatment for complicated urinary tract infection after kidney transplantation. Transpl Int. 2021 Dec;34(12):2686-2695. doi: 10.1111/tri.14144. Epub 2021 Nov 9. PMID: 34668610.

Anesi JA et al. Impact of donor multidrug-resistant organisms on solid organ transplant recipients. Transpl Infect Dis 2021 Dec 30;e13783. Doi: 10.111/tid.13783. PMID: 34968006.

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