Ardila CM, Yadalam PK, Ramírez-Arbelaez J. Efficacy of antimicrobials in preventing resistance in solid organ transplant recipients: A systematic review of clinical trials. World J Transplant 2025; 15(1): 98003 [DOI: 10.5500/wjt.v15.i1.98003]
Corresponding Author of This Article
Carlos M Ardila, Doctor, MSc, PhD, Academic Research, Associate Professor, Department of Basic Sciences, Biomedical Stomatology Research Group, Universidad de Antioquia U de A, Calle 70 52-21, Medellín 0057, Colombia. martin.ardila@udea.edu.co
Research Domain of This Article
Medical Informatics
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Mar 18, 2025; 15(1): 98003 Published online Mar 18, 2025. doi: 10.5500/wjt.v15.i1.98003
Efficacy of antimicrobials in preventing resistance in solid organ transplant recipients: A systematic review of clinical trials
Carlos M Ardila, Pradeep K Yadalam, Jaime Ramírez-Arbelaez
Carlos M Ardila, Department of Basic Sciences Faculty of Dentistry, Biomedical Stomatology Research Group, Universidad de Antioquia U de A, Medellín 0057, Colombia
Carlos M Ardila, Department of Postdoctoral Program, CIFE University Center, Cuernavaca 62330, Morelos, Mexico
Pradeep K Yadalam, Department of Periodontics, Saveetha Dental College, Saveetha Institute of Medical and Health, SIMATS, Saveetha University, Chennai 600077, Tamil Nadu, India
Jaime Ramírez-Arbelaez, Department of Transplantation, Hospital San Vicente Fundación, Rionegro 054047, Colombia
Author contributions: Ardila CM performed the conceptualization, data curation, data analysis, manuscript writing, and revision of the manuscript; Yadalam PK performed the data curation, data analysis, and revision of the manuscript; Ramírez-Arbeláez J performed the data curation, data analysis, and revision of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Carlos M Ardila, Doctor, MSc, PhD, Academic Research, Associate Professor, Department of Basic Sciences, Biomedical Stomatology Research Group, Universidad de Antioquia U de A, Calle 70 52-21, Medellín 0057, Colombia. martin.ardila@udea.edu.co
Received: June 14, 2024 Revised: September 26, 2024 Accepted: October 28, 2024 Published online: March 18, 2025 Processing time: 165 Days and 17 Hours
Abstract
BACKGROUND
In the absence of effective antimicrobials, transplant surgery is not viable, and antirejection immunosuppressants cannot be administered, as resistant infections compromise the life-saving goal of organ transplantation.
AIM
To evaluate the efficacy of antimicrobials in preventing resistance in solid organ transplant recipients.
METHODS
A systematic review was conducted using a search methodology consistent with the preferred reporting items for systematic reviews and meta-analyses. This review included randomized clinical trials that evaluated the efficacy of antimicrobial agents (prophylactic or therapeutic) aimed at preventing antimicrobial resistance. The search strategy involved analyzing multiple databases, including PubMed/MEDLINE, Web of Science, Embase, Scopus, and SciELO, as well as examining gray literature sources on Google Scholar. A comprehensive electronic database search was conducted from the databases’ inception until May 2024, with no language restrictions.
RESULTS
After the final phase of the eligibility assessment, this systematic review ultimately included 7 articles. A total of 2318 patients were studied. The most studied microorganisms were cytomegalovirus, although vancomycin-resistant enterococci, Clostridioides difficile, and multidrug-resistant Enterobacterales were also analyzed. The antimicrobials used in the interventions were mainly maribavir, valganciclovir, ganciclovir, and colistin-neomycin. Of concern, all clinical trials showed significant proportions of resistant microorganisms after the interventions, with no statistically significant differences between the groups (mean resistance 13.47% vs 14.39%), except for two studies that demonstrated greater efficacy of maribavir and valganciclovir (mean resistance 22.2% vs 41.1% in the control group; P < 0.05). The total reported deaths in three clinical trials were 75, and there were 24 graft rejections in two studies.
CONCLUSION
All clinical trials reported significant proportions of antimicrobial-resistant microorganisms following interventions. More high-quality randomized clinical trials are needed to corroborate these results.
Core Tip: This systematic review evaluates the efficacy of antimicrobial agents in preventing resistance among solid organ transplant recipients. Despite varying results across studies, maribavir and valganciclovir showed promise in reducing resistance rates compared to controls. However, overall, significant proportions of antimicrobial-resistant microorganisms were observed post-intervention, highlighting the urgent need for further high-quality randomized clinical trials to validate these findings and improve outcomes in organ transplantation.
