International Survey on Antibiotic Prophylaxis Approaches for Solid Organ Transplant Recipients and Donors Colonized With Multidrug‐Resistant Organisms

TL;DR

This study surveyed global practices for managing antibiotic prophylaxis in organ transplants when donors or recipients are colonized with drug-resistant bacteria.

Contribution

The paper provides the first international survey on antibiotic prophylaxis practices for transplants involving multidrug-resistant organisms.

Findings

Over half of centers modify prophylaxis based on donor colonization, mainly from urine and respiratory cultures.

Recipient screening for drug-resistant bacteria is common, especially for carbapenem-resistant Enterobacterales.

There is significant international variability in screening and prophylaxis approaches for multidrug-resistant organisms in transplants.

Abstract

Multidrug‐resistant organism colonization and infections cause significant morbidity and mortality in solid organ transplantation, affecting the perioperative antibiotic management. Yet, international practices for screening and antibiotic prophylaxis in colonized donors and recipients remain poorly defined.

Self‐administered, web‐based survey conducted between February and July 2025 to assess global practices in multidrug‐resistant organism screening and perioperative antibiotic management in SOT, developed by transplant infectious diseases experts and endorsed by the Transplant Infectious Diseases Section of the Transplantation Society and the European Society of Clinical Microbiology and Infectious Diseases Study Group for Infections in Compromised Hosts. Data collected included respondent and institution characteristics; screening and prophylaxis protocols; donor and recipient colonization management; and timeframes relevant for prophylaxis modification.

Responses from 125 transplant centers across 24 countries and four continents were included. Most respondents were infectious disease physicians (73.6%). Antimicrobial stewardship programs and transplant infectious diseases consultation were available in 93.6% and 85.6% of centers, respectively. Over half (52.0%) modified prophylaxis based on donor multidrug‐resistant organism colonization, mainly triggered by urine and respiratory cultures. Preservation fluid and surveillance cultures influenced decisions less often. Recipient screening protocols were reported by 61.6% of centers, primarily targeting carbapenem‐resistant Enterobacterales (80.8%). About 41.6% routinely adjusted prophylaxis for colonized recipients, especially with recent (1–3 months) colonization.

Substantial international variability exists in multidrug‐resistant organism screening and perioperative prophylaxis practices in solid organ transplantation. Evidence‐based consensus guidelines are needed to standardize and improve prevention of donor‐derived and recipient infections globally.

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