Efficacy of antimicrobials in preventing resistance in solid organ transplant recipients: A systematic review of clinical trials

Table 1 Search strategies implemented across selected databases

Database	Search strategy
PubMed/MEDLINE	[“Organ Transplantation” (MeSH) OR “Kidney Transplantation” (MeSH) OR “Liver Transplantation” (MeSH) OR “Heart Transplantation” (MeSH) OR “Lung Transplantation” (MeSH) OR “Pancreas Transplantation” (MeSH)] AND [“Anti-Bacterial Agents” (MeSH) OR “Antibiotics” (MeSH) OR “Antifungal Agents” (MeSH) OR “Antiviral Agents” (MeSH) OR “Antimicrobial Prophylaxis” (MeSH)] AND [“Drug Resistance, Microbial” (MeSH) OR “Drug Resistance, Bacterial” (MeSH) OR “Drug Resistance, Multiple, Bacterial” (MeSH) OR “Drug Resistance, Fungal” (MeSH) OR “Drug Resistance, Viral” (MeSH)] AND [“Infections” (MeSH) OR “Bacterial Infections” (MeSH) OR “Fungal Infections” (MeSH) OR “Viral Infections” (MeSH)]
Scopus	TITLE-ABS-KEY (“Organ Transplantation” OR “Kidney Transplantation” OR “Liver Transplantation” OR “Heart Transplantation” OR “Lung Transplantation” OR “Pancreas Transplantation”) AND (“Anti-Bacterial Agents” OR “Antibiotics” OR “Antifungal Agents” OR “Antiviral Agents” OR “Antimicrobial Prophylaxis”) AND (“Drug Resistance, Microbial” OR “Drug Resistance, Bacterial” OR “Drug Resistance, Multiple, Bacterial” OR “Drug Resistance, Fungal” OR “Drug Resistance, Viral”) AND (“Infections” OR “Bacterial Infections” OR “Fungal Infections” OR “Viral Infections”)
SciELO	[(“Organ Transplantation” OR “Kidney Transplantation” OR “Liver Transplantation” OR “Heart Transplantation” OR “Lung Transplantation” OR “Pancreas Transplantation”) AND (“Anti-Bacterial Agents” OR “Antibiotics” OR “Antifungal Agents” OR “Antiviral Agents” OR “Antimicrobial Prophylaxis”) AND (“Drug Resistance, Microbial” OR “Drug Resistance, Bacterial” OR “Drug Resistance, Multiple, Bacterial” OR “Drug Resistance, Fungal” OR “Drug Resistance, Viral”) AND (“Infections” OR “Bacterial Infections” OR “Fungal Infections” OR “Viral Infections”)]
Embase	(‘Organ Transplantation’/exp OR ‘Kidney Transplantation’/exp OR ‘Liver Transplantation’/exp OR ‘Heart Transplantation’/exp OR ‘Lung Transplantation’/exp OR ‘Pancreas Transplantation’/exp) AND (‘Anti-Bacterial Agents’/exp OR ‘Antibiotics’/exp OR ‘Antifungal Agents’/exp OR ‘Antiviral Agents’/exp OR ‘Antimicrobial Prophylaxis’/exp) AND (‘Drug Resistance, Microbial’/exp OR ‘Drug Resistance, Bacterial’/exp OR ‘Drug Resistance, Multiple, Bacterial’/exp OR ‘Drug Resistance, Fungal’/exp OR ‘Drug Resistance, Viral’/exp) AND (‘Infections’/exp OR ‘Bacterial Infections’/exp OR ‘Fungal Infections’/exp OR ‘Viral Infections’/exp)
Web of Science	TS = (“Organ Transplantation” OR “Kidney Transplantation” OR “Liver Transplantation” OR “Heart Transplantation” OR “Lung Transplantation” OR “Pancreas Transplantation”) AND TS = (“Anti-Bacterial Agents” OR “Antibiotics” OR “Antifungal Agents” OR “Antiviral Agents” OR “Antimicrobial Prophylaxis”) AND TS = (“Drug Resistance, Microbial” OR “Drug Resistance, Bacterial” OR “Drug Resistance, Multiple, Bacterial” OR “Drug Resistance, Fungal” OR “Drug Resistance, Viral”) AND TS = (“Infections” OR “Bacterial Infections” OR “Fungal Infections” OR “Viral Infections”)
Google Scholar	“Organ Transplantation” OR “Kidney Transplantation” OR “Liver Transplantation” OR “Heart Transplantation” OR “Lung Transplantation” OR “Pancreas Transplantation” AND “Anti-Bacterial Agents” OR “Antibiotics” OR “Antifungal Agents” OR “Antiviral Agents” OR “Antimicrobial Prophylaxis” AND “Drug Resistance, Microbial” OR “Drug Resistance, Bacterial” OR “Drug Resistance, Multiple, Bacterial” OR “Drug Resistance, Fungal” OR “Drug Resistance, Viral” AND “Infections” OR “Bacterial Infections” OR “Fungal Infections” OR “Viral Infections”

Table 2 Summary of the main characteristics of the studies

Ref.	Patients	Intervention/control	Microorganisms studied	Incidence of antimicrobial resistance	Adverse events
Rock et al[12]	1085	Routine and discharge patient room cleaning using ultraviolet-C light vs routine and discharge patient room cleaning	Vancomycin-resistant enterococci and Clostridioides difficile	6.52 vs 6.68 per 1000 patient-days in vancomycin-resistant enterococci (P > 0.05) and 3.78 vs 2.64 per 1000 patient-days in Clostridioides difficile infections (P > 0.05)	Not reported
Avery et al[13]	352	Maribavir 400 mg twice daily versus valganciclovir/ganciclovir, foscarnet, or cidofovir	Cytomegalovirus	44.4% vs 76.1% (P < 0.05)	40 deaths, dysgeusia, nausea, diarrhea
Fariñas et al[14]	105	Colistin-neomycin vs no treatment	Multidrug-resistant (Enterobacterales)	9.4% vs 13.5% (P > 0.05)	Diarrhea
Papanicolaou et al[15]	120	Maribavir 400, 800, or 1200 mg at a ratio of 1:1:1	Cytomegalovirus	30%, 37.5%, 27.5% (P > 0.05)	32 deaths, dysgeusia, nausea
Boivin et al[16]	275	Ganciclovir vs valganciclovir	Cytomegalovirus	2.3% vs 3.6% (P > 0.05)	2 deaths, gastrointestinal problem
Boivin et al[17]	80	Valganciclovir vs ganciclovir	Cytomegalovirus	2.5% vs 2.5% (P > 0.05)	1 death, 23 grafts rejected, abdominal pain, diarrhea
Boivin et al[18]	301	Valganciclovir vs ganciclovir	Cytomegalovirus	0% vs 6.1% (P < 0.05)	1 graft rejected

Table 3 Risk of bias and quality of the selected randomized clinical trials[11]

RCT	Randomization	Double blinding	Withdraw	Proper randomization	Proper double blinding	Score
Rock et al[12]	1	0	0	0	0	1
Avery et al[13]	1	0	1	1	0	3
Fariñas et al[14]	1	0	1	1	0	3
Papanicolaou et al[15]	1	1	1	1	1	5
Boivin et al[16]	1	0	0	0	0	1
Boivin et al[17]	1	0	0	0	0	1
Boivin et al[18]	1	1	0	0	0	2

RCT: Randomized controlled trial.