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Transplant patients are uniquely predisposed to infections with multidrug-resistant organisms both in the early and late phases after transplantation. Similarly, recipients of stem cell or solid organ allograft show greater susceptibility for often difficult-to-treat infections acquired during the extensive healthcare environmental contact and multidrug-resistant bacteria in patients’ community. Infections are frequently encountered during pretransplant period due to the undergoing neoplastic processes or end-stage organ disease and rarely unwittingly transmitted via an infected donor graft. Major risk factors for infections following transplantation procedures include prolonged hospitalization, prior systemic antibiotic exposure, surgeries, need for critical care unit stay, mechanical ventilation, and presence of indwelling intravascular and other body cavity devices. Antibiotic regimens are often more complex and in a vast number of transplant patients given empirically or preemptively. Drug-drug interactions with immunosuppressive medications and serious, treatment-limiting adverse reactions further complicate management of these high-risk individuals. Use of prophylactic antibiotics also contributes to selection of antibiotic resistance organisms and rarely development of de novo drug-resistant pathogen. Multiple studies have documented increased morbidity and mortality in the transplant population, especially due to bacteria such as Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Burkholderia cepacia, methicillin-resistant S. aureus, and vancomycin-resistant enterococci. This chapter will focus on the major classes of antibiotics including conventional drugs and new antimicrobials in development, mechanisms of resistance, and the indications for use in the transplant population.

DOI: 10.1007/978-1-4939-9034-4_50