Current state of antimicrobial stewardship in solid organ transplantation in Israel

Tomer Hoffman*, Alaa Atamna, Eugene Katchman, Efrat Orenbuch-Harroch, Lior Nesher, Roni Bitterman, Dafna Yahav, Amir Nutman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: We aimed to review the current state, challenges, and needs of antimicrobial stewardship programs (ASPs) in adult solid organ transplantation (SOT) centers in Israel. Methods: We conducted a survey using electronic questionnaires sent during February 2022 to infectious disease (ID) consultants of SOT centers, encompassing general and organ-specific ASP issues. Results: All six centers performing adult SOTs in Israel participated. The institutional ASPs in all centers included SOT recipients, and five centers had specific stewardship activities targeting SOT recipients. ASP activities were performed by ID consultants in all centers, with clinical pharmacists in most. ASP protocols and activity scope were highly variable. Formulary restriction with pre-authorization was used in all centers. Antibiotic allergy was addressed in ASP guidelines in half of the centers. Peri-transplantation antibiotic, antifungal, and antiviral prophylactic regimens varied based on center, transplanted organ, and patient risk group. Approaches to surveillance cultures, diagnosis and treatment of various graft infections were also variable. ASP outcome measurement was not performed in all centers. The main challenges and barriers to successful ASP implementation were difficulty in defining appropriate durations of therapy for certain infections, high rates of antimicrobial resistance (AMR), and lack of dedicated ASP teams. Conclusion: Antimicrobial stewardship in SOT centers in Israel is performed by ID consultants and practices vary. Challenges are related to high AMR rates, insufficient evidence to support practices, lack of dedicated ASP teams, and lack of outcome measurement. There is an urgent need to establish a national collaborative program including all SOT centers.

Original languageEnglish
Article numbere13875
JournalTransplant Infectious Disease
Volume24
Issue number5
DOIs
StatePublished - Oct 2022

Keywords

  • Israel
  • antimicrobial stewardship
  • national survey
  • solid organ transplantation

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