Non-tuberculous mycobacteria (NTM) infections are challenging to recognize, diagnose, and manage, particularly in lung transplant recipients. The aim of this review is to provide recommendations for diagnosis, treatment (including key drug-drug interactions of antimycobacterial agents and immunosuppressants), and long-term management of NTM infections in lung transplant recipients. Two systematic meta-analyses, both published in 2023, analyzed NTM infection in lung transplant recipients, and both found that NTM disease was associated with higher mortality after lung transplantation. These findings underscore the importance of future study in this field. Clinicians should be cognizant of novel effective antimycobacterial agents, such as omadacycline for rapid growing mycobacteria. NTM infections pose a significant threat to lung transplant recipients, but these infections can be managed effectively in medical centers with experience in treating mycobacteria. The key management points are to consider all potential drug-drug interactions, consider the limitations of in vitro susceptibility testing, consider utilization of new antimycobacterial agents, and to consider close monitoring of patient’s symptoms and culture results.
Staphylococcus aureus is a major public health concern due to its ability to cause severe and complicated infections across multiple organs. Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant global threat, as it readily acquires resistance to various antibiotic classes. Its strong biofilm-forming capacity further complicates treatment in clinical settings. This review aims to explore the therapeutic potential of bacteriophages (phages) against S. aureus infections, highlighting their advantages, limitations, and challenges. Phage therapy has re-emerged as a promising approach for combating bacterial pathogens, including S. aureus. Lytic bacteriophages have demonstrated potential in managing localized and systemic bacterial infections. Recent studies have provided insights into the efficacy of phage therapy, suggesting it could complement or replace traditional antibiotic treatments, especially for multidrug-resistant strains like MRSA. The increasing prevalence of antibiotic resistance in S. aureus necessitates innovative treatment strategies. Phage therapy offers a viable alternative with significant therapeutic promise. However, further research must focus on addressing challenges such as resistance development, regulatory hurdles, and optimization of therapeutic protocols.
Machine perfusion strategies reduce the duration of organ ischemia and minimize tissue damage, increasing use of organs previously considered unsuitable for transplant. This review outlines the basic principles of organ preservation and machine perfusion, describes the risk of microbial contamination and role of antimicrobials during machine-based preservation, and discussed opportunities to leverage machine perfusion to reduce the risk of disease transmission. Ex situ machine perfusion (ESMP), which involves circulating perfusate through an organ’s vasculature to maintain physiological function, introduces new infectious considerations tied to its inherent function and real-world applications. Antimicrobials are routinely added to the perfusate in normothermic machine perfusion to mitigate the risk of microbial growth at normothermia. Microbial growth in ESMP perfusate has been described, but cultures often contain low-virulence organisms that do not predict post-transplant infection. Manipulation of organs on ESMP has been evaluated as a method to reduce the risk of infection transmission, but ESMP is not currently used for this purpose. Current data do not suggest that ESMP systems confer a clinically significant infection risk over traditional preservation methods, but large, multicenter, prospective studies are needed to better understand infection risk. Universal treatment of recipients with antimicrobials targeting preservation fluid cultures is likely to be unnecessary, but the benefits of targeted treatment of certain potential pathogens could outweigh the risks. ESMP offers a potential platform for targeting donor-derived pathogens, but optimization of ex situ manipulation will be required for it to be an effective infection prevention approach.
Refractory post-transplant CMV, with or without genotypic resistance, remains a challenging issue. Antivirals traditionally used for refractory CMV include foscarnet and cidofovir, which have major toxicities and suboptimal efficacy. In 2021, maribavir became the first antiviral drug approved for treatment of refractory CMV with or without resistance defined by genetic mutations (resistant/refractory CMV or “R/R” CMV). However, much remains to be learned. This review presents an illustrative case and summarizes current literature on real-world outcomes of maribavir treatment, as well as other interventions for R/R CMV. Several post-marketing case series regarding real-world use of maribavir for R/R CMV have reported successful outcomes in 40–67
This review offers a comprehensive and up-to-date overview of mpox virus (MPXV) infection, highlighting its evolving epidemiology, virological features, transmission patterns, clinical presentation, and diagnostic methods. Particular attention is given to current treatment options and preventive strategies, including vaccination. The review emphasizes insights from recent outbreaks and advances in therapeutic development. Since 2022, MPXV has emerged as a global public health concern with sustained human-to-human transmission, primarily through sexual contact, especially among men who have sex with men and people living with HIV. New viral clades, including clades 1b and 2b, have been identified, exhibiting genetic adaptations that enhance human infectivity. Although tecovirimat remains the primary antiviral treatment, emerging resistance and limited clinical efficacy data raise concerns. Several vaccine platforms, particularly MVA-BN, are in use or under evaluation, though issues remain regarding long-term protection and global accessibility. Mpox has shifted from an endemic zoonosis to a sexually transmitted infection with global reach. While most cases are self-limited, severe disease can occur in immunocompromised individuals. The current therapeutic armamentarium is restricted, and tecovirimat’s utility may be limited by timing, resistance, and viral clade. Vaccination is effective, but not universally available or durable. Enhanced surveillance, improved diagnostics, novel antivirals, and equitable vaccine access are crucial for containment. A One Health approach is essential to address ongoing transmission risks and potential spillover events.
