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.

中文翻译：

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制定和实施管理举措以优化实体器官移植受者巨细胞病毒感染的预防和治疗

经典的管理工作针对免疫功能正常的患者；然而，在免疫功能低下的宿主中适当使用抗菌剂已成为人们关注的目标。巨细胞病毒 (CMV) 感染是实体器官移植 (SOT) 后最常见和最严重的并发症之一。CMV 的治疗需要抗病毒药物治疗和减少免疫抑制的双重方法以获得最佳结果。这种 CMV 管理的双重方法增加了复杂性，并且需要个体化治疗以平衡抗病毒功效与同种异体移植物排斥的风险。在这篇综述中，我们重点关注 CMV 管理计划的制定和实施，作为免疫功能低下宿主中抗菌药物管理的一个组成部分，以优化 SOT 受者中 CMV 的预防和治疗管理。