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The development and implementation of stewardship initiatives to optimize the prevention and treatment of cytomegalovirus infection in solid-organ transplant recipients

Published online by Cambridge University Press:  27 May 2020

Margaret R. Jorgenson Open the ORCID record for Margaret R. Jorgenson [Opens in a new window] ,
Jillian L. Descourouez ,
Lucas T. Schulz ,
Kerry A. Goldrosen ,
John P. Rice ,
Robert R. Redfield ,
Christopher M. Saddler ,
Jeannina A. Smith  and
Didier A. Mandelbrot
Margaret R. Jorgenson*
Affiliation:
Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
Jillian L. Descourouez
Affiliation:
Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
Lucas T. Schulz
Affiliation:
Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
Kerry A. Goldrosen
Affiliation:
Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
John P. Rice
Affiliation:
Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
Robert R. Redfield
Affiliation:
Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
Christopher M. Saddler
Affiliation:
Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
Jeannina A. Smith
Affiliation:
Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
Didier A. Mandelbrot
Affiliation:
Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
*
Address for correspondence: Margaret Jorgenson, E-mail: MJorgenson@uwhealth.org
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Abstract

Classical stewardship efforts have targeted immunocompetent patients; however, appropriate use of antimicrobials in the immunocompromised host has become a target of interest. Cytomegalovirus (CMV) infection is one of the most common and significant complications after solid-organ transplant (SOT). The treatment of CMV requires a dual approach of antiviral drug therapy and reduction of immunosuppression for optimal outcomes. This dual approach to CMV management increases complexity and requires individualization of therapy to balance antiviral efficacy with the risk of allograft rejection. In this review, we focus on the development and implementation of CMV stewardship initiatives, as a component of antimicrobial stewardship in the immunocompromised host, to optimize the management of prevention and treatment of CMV in SOT recipients. These initiatives have the potential not only to improve judicious use of antivirals and prevent resistance but also to improve patient and graft survival given the interconnection between CMV infection and allograft function.

Type
Review
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 9 , September 2020 , pp. 1068 - 1074
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© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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