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To the Editor:

We read with interest the recently published Infectious Disease Guidelines of the American Society of Transplantation (AST), and commend the Infectious Diseases Community of Practice for the timely release of these comprehensive guidelines [1]. We are disappointed, however, to see that a cohesive approach to developing an antimicrobial stewardship program (ASP) within the transplant community was not described. ASPs can have a positive impact on limiting the prevalence of multidrug resistant (MDR) infections, a focus of several of the new guidelines. Transplant recipients are disproportionately affected by MDR bacteria, with prolonged exposure to broad-spectrum antimicrobial agents often present as the sole risk factor for their development [2].

Numerous studies have shown that various stewardship interventions are able to decrease inappropriate use of antimicrobials and limit the rise of resistant bacteria without a concomitant decline in clinical outcomes [3]. While the impact of ASPs in a transplant-specific population has not been formally evaluated, hospital-level and multicenter studies evaluating the impact of ASPs frequently include solid organ transplant recipients as part of their target population. Additionally, the benefit of ASPs in limiting the rise of MDR bacteria may extend as collateral benefit to transplant patients, as admission to rooms that were previously occupied by patients colonized with MDR bacteria has been shown to be an independent risk factor for the acquisition of MDR bacteria by subsequent patients [4].

The Infectious Diseases Society of America, Society for Healthcare Epidemiology of America and Pediatric Infectious Diseases Society have recently released a position statement calling for mandatory implementation of ASPs throughout the healthcare system [5]. We believe that the transplant community is a key stakeholder in this mandate, serving a patient population that is likely to derive the greatest benefit from its implementation. Through formal guidance and recommendations to its members on the implementation of antimicrobial stewardship, we believe that AST can have a lasting, positive impact on the well-being of the patients it serves. We call upon AST to adopt comprehensive guidelines for antimicrobial stewardship to further this goal.

  • S. L. Aitken1,2, H. R. Palmer1, J. E. Topal3,4, S. Gabardi5, and E. Tichy4,6

  • 1St. Luke's Episcopal Hospital, Houston, TX

  • 2University of Houston College of Pharmacy, Houston, TX

  • 3Yale University School of Medicine, New Haven, CT

  • 4Yale-New Haven Hospital, New Haven, CT

  • 5Brigham and Women's Hospital, Boston, MA

  • 6Yale-New Haven Transplant Center, New Haven, CT

  • *Corresponding author: Samuel L. Aitken, saitken@sleh.com

Disclosures

All authors report no conflicts of interest relevant to this publication.

References

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  • 1
    Blumberg EA, Danziger-Isakov L, Kumar D, Michaels MG, Razonable RR. Foreword: Guidelines 3. Am J Transplantation 2013; 13(S4): 12.
  • 2
    O'Fallon E, Kandel R, Schreiber R, D'Agata EM. Acquisition of multidrug-resistant gram-negative bacteria: Incidence and risk factors within a long-term care population. Infect Control Hosp Epidemiol 2010; 31: 11481153.
  • 3
    Kaki R, Elligsen M, Walker S, et al. Impact of antimicrobial stewardship in critical care: A systematic review. J Antimicrob Chemother 2011; 66: 12231230.
  • 4
    Nseir S, Blazejewski C, Lubret R, et al. Risk of acquiring multidrug-resistant Gram-negative bacilli from prior room occupants in the intensive care unit. Clin Microbiol Infect 2011; 17: 12011208.
  • 5
    Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol 2012; 33: 322327.