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Preserving the effectiveness of antimicrobials remains crucial, as otherwise transplant surgeries would be unsafe due to surgical site infections, and the risk of sepsis with neutropenia would preclude stem cell transplant. In this review, we provide updates on three previously discussed stewardship challenges: febrile neutropenia, <jats:italic>Clostridioides difficile<\/jats:italic> infection, and asymptomatic bacteriuria. We also offer insight into four new stewardship challenges: the applicability of the \u201cshorter is better\u201d paradigm shift to antimicrobial duration; antibiotic allergy delabeling and desensitization; colonization with multidrug-resistant gram-negative organisms; and management of cytomegalovirus infections. Specifically, data are accumulating for \u201cshorter is better\u201d and antibiotic allergy delabeling in transplant patients, following successes in the general population. Unique to transplant patients are the impact of multidrug-resistant organism colonization on clinical decision-making of antibiotic prophylaxis in transplant procedure and the need for antiviral stewardship in cytomegalovirus. We highlighted the expansion of antimicrobial stewardship interventions as potential solutions for these challenges, as well as gaps in knowledge and opportunities for further research.<\/jats:p>","DOI":"10.1017\/ash.2023.517","type":"journal-article","created":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T09:49:00Z","timestamp":1704966540000},"source":"Crossref","is-referenced-by-count":5,"title":["Bring it on again: antimicrobial stewardship in transplant infectious diseases: updates and new 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