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The article discusses the impact of sulfonamide allergy labels on the risk of opportunistic infections after solid organ transplantation (SOT). SOT recipients with a sulfonamide allergy label were found to have an increased risk of Toxoplasma and Nocardia infections compared to those without the label. The study highlights the importance of reassessing sulfonamide allergy labels in SOT recipients to optimize prophylactic treatment and reduce the risk of opportunistic infections. Efforts should be made to identify safe delabeling strategies and promote the use of trimethoprim/sulfamethoxazole (TMP‐SMX) in eligible SOT recipients. [Extracted from the article]

Background Methods Results Conclusion Despite the burden of pyelonephritis after kidney transplantation, there is no consensus on initial empirical antibiotic management.We surveyed clinicians throughout the world on their practice and opinions about the initial empirical therapy of post‐transplant pyelonephritis, using clinical vignettes. A panel of experts from 19 countries on six continents designed this survey, and invited 2145 clinicians to participate.A total of 721 clinicians completed the survey (response rate: 34%). In the hypothetical case of a kidney transplant recipient admitted with pyelonephritis but not requiring intensive care, most respondents reported initiating either a 3rd‐generation cephalosporin (37%) or piperacillin‐tazobactam (21%) monotherapy. Several patient‐level factors dictated the selection of broader‐spectrum antibiotics, including having a recent urine culture showing growth of a resistant organism (85% for extended‐spectrum ß‐lactamase‐producing organisms, 90% for carbapenemase‐producing organisms, and 94% for Pseudomonas aeruginosa). Respondents attributed high importance to the appropriateness of empirical therapy, which 87% judged important to prevent mortality. Significant practice and opinion variations were observed between and within countries.High‐quality studies are needed to guide the empirical management of post‐transplant pyelonephritis. In particular, whether prior urine culture results should systematically be reviewed and considered remains to be determined. Studies are also needed to clarify the relationship between the appropriateness of initial empirical therapy and outcomes of post‐transplant pyelonephritis. [ABSTRACT FROM AUTHOR]

Background: Little is known regarding the optimal management of nocardiosis among solid organ transplant (SOT) recipients. It is often suggested to avoid trimethoprim/sulfamethoxazole (TMP‐SMX) monotherapy in heavily immunocompromised patients (such as SOT recipients) and/or in case of severe or disseminated nocardiosis. Our aim was to report our experience with TMP‐SMX monotherapy in SOT recipients with nocardiosis. Methods: Using data from a previously published European study, we assessed the incidence of adverse events in SOT recipients receiving TMP‐SMX monotherapy and assessed its effectiveness. Results: Thirty‐one SOT recipients with nocardiosis were included, mostly kidney transplant recipients (20/31, 65%). Eleven (36%) had disseminated infection, and four (13%) had brain nocardiosis. Most patients had lung and/or pleural involvement (26/31, 84%). Daily dose of trimethoprim at initiation was 10 [6.4‐14.8] mg/kg. The median estimated glomerular filtration rate at time of diagnosis of nocardiosis was 44 [30‐62] ml/min/1.73 m². TMP‐SMX was discontinued prematurely in one third of the patients (10/31, 32%, mostly for hematological toxicity [n = 3] or increased serum creatinine [n = 3]). Focusing on the 24 (77%) patients who completed at least 30 days of TMP‐SMX monotherapy, 4 had late (>30 days) drug discontinuation, 1 experienced treatment failure, and 19 completed planned TMP‐SMX monotherapy. Clinical outcome was favorable in these 19 patients, despite the fact that 8 (42%) had disseminated infection and 2 (11%) brain nocardiosis. Overall, all‐cause 1‐year mortality was 10% (3/31). Conclusions: TMP‐SMX monotherapy appears to be effective for the treatment of most nocardiosis among SOT recipients. Interventional studies are needed to compare its safety and effectiveness with those of other regimens used to treat posttransplant nocardiosis. [ABSTRACT FROM AUTHOR]

The survey done by Kumar and colleagues also shows that infectious diseases physicians and transplant physicians have different perspectives on the management of kidney transplant recipients with pyelonephritis. Dear Editor, The kidney is by far the most commonly transplanted organ, and urinary tract infection is the most common infection after kidney transplantation.[1] Despite that, many clinical questions remain understudied, and therefore unanswered, regarding the optimal management of kidney transplant recipients with urinary tract infection.[2] This is particularly true for pyelonephritis, that is, a major event that generally requires hospital admission, decreases kidney graft function, and reduces quality of life among kidney transplant recipients. [Extracted from the article]

Background: Scedosporium species and Lomentospora prolificans (S/L) are the second most common causes of invasive mold infections following Aspergillus in lung transplant recipients. Methods: We assessed the current practices on management of S/L colonization/infection of the lower respiratory tract before and after lung transplantation in a large number of lung transplant centers through an international practice survey from October 2016 to March 2017. Results: A total of 51 respondents from 45 lung transplant centers (17 countries, 4 continents) answered the survey (response rate 58%). S/L colonization was estimated to be detected in candidates by 48% of centers. Only 18% of the centers used a specific medium to detect S/L colonization. Scedosporium spp. colonization was a contraindication to transplantation in 10% of centers whereas L prolificans was a contraindication in 31%; 22% of centers declared having had 1‐5 recipients infected with S/L in the past 5 years. Conclusions: This survey gives an overview of the current practices regarding S/L colonization and infection in lung transplant centers worldwide and underscores the need of S/L culture procedure standardization before implementing prospective studies. [ABSTRACT FROM AUTHOR]

Background: There is no consensus on the optimal management of immunosuppression during bacterial infections among solid organ transplant recipients. Methods: A multicenter, cross‐sectional survey, of high‐volume kidney and liver transplant centers across US and Europe. Structured questionnaires including six multiple‐choice questions concerning the management of immunosuppression during infection were distributed among 381 centers. Results: A total of 124 (33%) centers fully completed the questionnaire: 67 liver, 57 kidney centers. Participating centers reported heterogenous approaches to immunosuppression management for all types of immunosuppressive drugs. Notably, kidney centers reported similar frequencies of either discontinuation (19%), continuation (19%), or dose reduction (17.5%) of antimetabolites; discontinuation only for life‐threatening infection (17.5%) or case by case decisions (27%). Calcineurin inhibitors (CNI) management was heterogenous mostly among liver centers, with 8% discontinuing the CNI, 18% continuing, and 22% reducing dose. Heterogenous approaches to management of steroids and inhibitors of the mammalian target of rapamycin were also demonstrated. Conclusions: Immunosuppression management during bacterial infection is heterogenous in US and European centers. Immunosupression reduction (ISR) during infection is a common practice, though supported by limited evidence. Demonstrating high heterogeneity in the approach to ISR, together with the equivocal results of clinical studies, support consideration of an interventional clinical trial. [ABSTRACT FROM AUTHOR]