Antimicrobial Prophylaxis in Solid Organ and Hematopoietic Stem Cell Transplantation: A Survey Among Member Centers of the European Reference Network
                    <scp>TransplantChild</scp>

doi:10.1111/petr.70379

DOI: 10.1111/petr.70379 ISSN: 1397-3142

Antimicrobial Prophylaxis in Solid Organ and Hematopoietic Stem Cell Transplantation: A Survey Among Member Centers of the European Reference Network TransplantChild

Daniele Donà, Cecilia Liberati, Enrico Aidala, Zivile Bekassy, Anna Bjerre, Victoria Bordon, David Bueno Sanchez, Antonia H. M. Bouts, Luz Yadira Bravo‐Gallego, Valeria Casotti, Silvia Catalano, Patricia Costa‐Reis, Ugo Cucinotta, Dominique Debray, Huib De Jong, Francisco De la Cerda‐Ojeda, Olga De la Serna, Sandra Ferreira, Björn Fischler, Luis García Guereta, Nuria Gil, Marta González Vincent, Ferran Gran‐Ipiña, Ryszard Grenda, Daniela Grima, Uta Herden, Maria Loreto Hierro, Jorge Huerta, Timo Jahnukainen, Augustina Jankauskiene, Piotr Kaliciński, Karsten Kötz, Maria Francelina Lopes, Mercedes Lopez Gonzales, Álvaro Madrid, Maria Mercadal‐Hally, Julia Marsal, Antonio Marzollo, Karin Mellgren, Natalia Mendoza‐Palomar, Frauke Mutschler, Michal Odermarsky, José María Pérez‐Hurtado De Mendoza, Licia Peruzzi, Andra Pietrobattista, Michele Pinon, Agnieszka Prytula, Esther Boluda Ramos, Giusy Ranucci, Jelena Rascon, Francesco Saglio, Ana Rita Sandes, Marco Sciveres, Nicolaus Schwerk, Kalid Sharif, Søren Schwartz Sørensen, Xavier Stephenne, Clodagh Sweeney, Ana Texeira, Martin Tepel, Dominik Turkiewicz, Inga Vainumae, Anita Verma, Håkan Wåhlander, Adriana Warrington, Lars Wennberg, Susanne Westphal, Brigitte W. M. Willemse, Tom Wolfs, Alejandro Zarauza, Elisa Benetti, Francisco Hernández ‐ Oliveros,

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ABSTRACT

Background

Antimicrobial management in pediatric transplantation lacks standardized international guidelines, and current practices across European transplant centers remain poorly described. This study aimed to evaluate microbiological screening and peri‐transplant antimicrobial strategies among centers participating in the European Reference Network on Transplantation in Children (ERN TransplantChild), including both solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) programs.

Methods

Between December 2022 and February 2023, healthcare professionals within the network completed a structured survey addressing microbiological screening practices and peri‐transplant antimicrobial strategies in pediatric transplant recipients.

Results

Of 127 transplant programs invited, 76 (59.8%) responded, including 62 SOT and 14 HSCT programs from 36 centers across 16 European countries. Pre‐transplant screening strategies, microbiological methods, and decolonization practices varied substantially between centers. Reported prevalence of methicillin‐resistant Staphylococcus aureus and extended‐spectrum β‐lactamase–producing organisms was below 10% in most programs. In SOT, perioperative prophylaxis varied according to transplanted organ type. Cephalosporins were most commonly used in kidney and heart transplantation, whereas broader‐spectrum regimens, including piperacillin–tazobactam and vancomycin, were more frequently adopted in liver, intestinal, and lung transplantation. Postoperative prophylaxis was continued beyond 24 h in most SOT programs. Antifungal prophylaxis was more commonly adopted in liver, intestinal, and lung transplant recipients. In HSCT, antibacterial peri‐transplant use was not routinely prescribed in a substantial proportion of programs, particularly in autologous transplantation, whereas antifungals were widely used in allogeneic HSCT.

Conclusions

Marked heterogeneity in microbiological screening and peri‐transplant antimicrobial strategies across European pediatric transplant centers underscores the need for transplant‐specific, evidence‐based guidelines distinguishing between SOT and HSCT settings. These findings provide a foundation for the development of shared clinical pathways and harmonized recommendations.