4.1 ‑Multidrug Resistant Pseudomonas aeruginosa
in Solid Organ transplant Recipients
Christian van Delden, Geneva, Switzerland

Persistent colonization and infections with MDR Pseudomonas aeruginosa have been reported especially for lung, but also renal and liver transplant recipients. Pre-transplant colonization of CF-lung transplant recipients by MDR P. aeruginosa has been reported as high as 52%, with a post-transplant rise up to 75%. Independent of its resistance phenotype P. aeruginosa might also impact survival of lung transplant recipients by favoring the development of bronchiolitis obliterans (BOS). Mortality of MDR P. aeruginosa bacteremia among transplant recipients is high reaching 40%.

Repeated exposure to antimicrobial therapies is frequent after transplantation and not only increases the risk for colonization by antibiotic susceptible P. aeruginosa, but also by MDR P. aeruginosa isolates.

Treatment for MDR P. aeruginosa infections in solid transplant recipients remains controversial. There are no controlled trials of treatment for MDR P. aeruginosa specifically in these patients. Most transplant centers use combination therapies including two or three different classes (beta-lactam + aminoglycoside +/- fluoroquinolone) of antimicrobials. The role of colistin either as adjunctive aerosolized therapy, or as intravenous mono- or combination therapy remains unclear.

In this presentation we will focus on the epidemiology, risk factors, outcome and treatment options for these challenging infections.