Transplantology and nephrology Terapia 2021, 12 ( 407 ) : 18 - 21
Antibiotic resistance in transplantology
Summary:
Antibiotic resistance is the result of the evolution of bacteria that, through exposure to drugs, produce and combine survival mechanisms under adverse conditions. These mechanisms include production of enzymes that break down drug molecules (e.g. β-lactamases), modification of the antibiotic target or its transporters, pumping a therapeutic agent out of a cell or production of biofilm by a population of microorganisms. The level of antibiotic resistance in the world is growing rapidly due to misuse and abuse of antibiotics in human and veterinary medicine. Antibiotic-resistant bacteria are an increasing challenge in the treatment of infections especially in patients with weakened immune system such as transplant recipients. Frequent hospital stays, immunosuppression, the presence of catheters and alterations in the anatomy of the operated site are risk factors for the development of infections in this group of patients. Higher risk of bacterial infections induces higher exposure to antibiotics and therefore the potential selection of strains resistant to treatment. Examples of dangerous bacteria that are increasingly causing infections in transplant recipients are carbapenemase-producing Enterobacteriaceae (e.g. Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa), vancomycin-resistant staphylococci and linezolid-resistant enterococci. Treatment methods for infections caused by multi-drug resistant bacteria are limited due to the shortage of new antibiotics, potential toxicity of some drugs for the transplanted organ and interactions of available medicines with immunosuppression. Non-pharmacological methods of reducing the risk of infections are important, such as compliance with hand hygiene by medical staff and patients, encouraging populational vaccination or avoiding large gatherings, especially in the first months after transplantation when the administered immunosuppressive therapy high. It is also important to develop modern therapeutic methods that can replace or supplement treatment with antibiotics in the group of transplant patients.
Keywords: bacterial resistance, antibiotic resistance in transplantology, multi-drug resistant bacteria, antibiotics, infections in transplantology
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