Hyperammonemia Syndrome Due to Ureaplasma and Mycoplasma Infections in Solid Organ Transplant Recipients: Treatment and Prophylaxis Strategies

Hyperammonemia syndrome (HS) linked to Ureaplasma and Mycoplasma infections was first identified in lung transplant recipients. It is a highly morbid syndrome with mortality estimated to be as high as 70%. Yet there remains no consensus as to the best treatment and prophylaxis strategies. We aim to review existing data to guide decisions about choice and duration of empiric antimicrobials for HS secondary to Mollicute infections. Fluroquinolones, tetracyclines, macrolides, and lincosamides are the preferred agents for the treatment of Ureaplasma and Mycoplasma infections. Resistance to these agents remains low in the USA; however, rates vary significantly worldwide. The ideal duration of treatment is ill-defined although a 14-day course is often employed for HS. A high index of suspicion and rapid initiation of therapy is critical for the diagnosis and prognosis of hyperammonemia syndrome from Ureaplasma and Mycoplasma infections. However, close consideration must be given to the choice of empiric antimicrobials as significant species specific and regional variation in resistance rates has been reported.