Pandemic-associated shifts in microbial ecology and antimicrobial resistance in a high-volume liver transplant intensive care unit: a 10-year surveillance study

This is the authors' abstract. We don't add key points for this paper.

Background: Healthcare-associated infections (HAIs) remain a major source of morbidity in solid organ transplant recipients, particularly in liver transplant (LT) intensive care units (ICUs), where profound immunosuppression and extensive antimicrobial exposure shape local microbial ecology. While reductions in overall infection incidence have been reported in structured surveillance programs, longitudinal changes in pathogen distribution and antimicrobial resistance (AMR) in transplant-specific ICUs remain insufficiently characterized. We aimed to evaluate pandemic-associated shifts in microbial ecology and AMR patterns across a 10-year surveillance period in a high-volume LT ICU. Methods: value <0.05 was considered statistically significant. Results: exhibited increased ciprofloxacin resistance in 2020-2024 compared with 2015-2019. Conclusions: In this transplant-specific ICU, microbial ecology and resistance trajectories evolved independently of overall infection incidence trends. Pandemic-associated healthcare disruptions were accompanied by organism-specific resistance shifts rather than uniform ecological changes. Continuous surveillance and locally tailored antimicrobial stewardship strategies are essential to preserve therapeutic efficacy and mitigate the growing threat of multi-drug-resistant (MDR) pathogens in transplant ICUs.