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World J Gastroenterol. May 28, 2014; 20(20): 6201-6210
Published online May 28, 2014. doi: 10.3748/wjg.v20.i20.6201
Multidrug-resistant bacterial infections after liver transplantation: An ever-growing challenge
Guilherme Santoro-Lopes, Erika Ferraz de Gouvêa
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
Guilherme Santoro-Lopes, Department of Preventive Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ-CEP 21941-590, Brazil
Author contributions: Santoro-Lopes G and De Gouvêa EF performed the review of the literature, drafted and defined the content of the manuscript and approved the final version.
Correspondence to: Guilherme Santoro-Lopes, MD, PhD, Infectious Diseases Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Rodolpho Paulo Rocco, 255, Ilha do Fundão, Rio de Janeiro, RJ-CEP 21941-913, Brazil.
Telephone: +55-21-25622526 Fax: +55-21-22542694
Received: November 1, 2013
Revised: January 30, 2014
Accepted: March 12, 2014
Published online: May 28, 2014

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.

Keywords: Multidrug resistance, Bacterial infections, Organ transplantation, Methicillin-resistant Staphylococcus aureus, Liver transplantation

Core tip: Infections caused by multidrug-resistant bacteria have been a growing cause of concern for those involved in the care of solid organ transplant recipients all over the world. The emergence of various pathogens with extensive antibiotic resistance creates a challenging scenario. This article presents an overview of the available epidemiological and clinical data on the most common multidrug-resistant bacterial infections among liver transplant recipients. Currently recommended therapeutic and preventive interventions are also summarized.