Bacteria are the leading cause of infections after solid organ transplantation. In the recent years, a progressive growth in the incidence of multi-drug resistant strains has been observed. While MRSA infection is declining in non-transplant and SOT patients worldwide, vancomycin-resistant enterococci, MDR/XDR Enterobacteriaceae and MDR/XDR non-fermenters are progressively growing as a cause of infection is SOT patients and represent a global threat. Some SOT patients develop recurrent infections, related to anatomical defects in many cases, which are difficult-to-treat and predispose to the acquisition of MDR pathogens. As the antibiotics active against MDR bacteria have several limitations for its use, which include less clinical experience, higher incidence of adverse effects, less knowledge of the pharmacokinetics of the drug and, in most cases, are only available for parenteral administration, it is mandatory to know deeply the main characteristics of these drugs to safely treat SOT patients with MDR bacterial infections. Nonetheless, preventive measures are the cornerstone to control the spread of these pathogens. Thus, applying the CDC’s and ESCMID’s recommended antibiotic policies and strategies to control the transmission of MDR strains in the hospital is essential for the management of SOT patients.

In this lecture, a description of the recommendations proposed by the ESCMID Study Group for Infections in Compromised Hosts for the prevention and management of MDR bacteria infections in solid organ transplantation will be discussed.