Bacterial meningitis as a cause of death in lung transplant donors: Early outcomes in recipients

Grewal, Harpreet; Highland, Kristin B.; McCurry, Kenneth R.; Akindipe, Olufemi; Budev, Marie; Mehta, Atul C.

doi:10.1111/ctr.13307

Cited by 8 publications

(5 citation statements)

References 22 publications

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“…Moreover, mNGS showed absolute superiority in the detection of virus and parasite. Viral infection after lung transplant is common and classified into diseases caused by cytomegalovirus or by other community-acquired respiratory viruses (4,29). It has been reported that viral pathogens are involved in 25 of 71 infectious episodes in a cohort of lung transplant recipients, with cytomegalovirus-related diseases accounting for 68% of them (8).…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, the morbidity and mortality remain high, and the survival rate in lung transplant recipients is lower than of other solid organ transplant recipients, with a 5-year survival rate of 55.6% ( 3 ). Rejection- and infection-related complications are the main factors for overall morbidity and mortality in lung transplant recipients ( 4 , 5 ). For lung transplant recipients, infection is a significant complication.…”

Section: Introductionmentioning

confidence: 99%

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Etiologic characteristics revealed by mNGS-mediated ultra-early and early microbiological identification in airway secretions from lung transplant recipients

Zhang,

Tang,

et al. 2023

Front. Immunol.

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BackgroundPost-operative etiological studies are critical for infection prevention in lung transplant recipients within the first year. In this study, mNGS combined with microbial culture was applied to reveal the etiological characteristics within one week (ultra-early) and one month (early) in lung transplant recipients, and the epidemiology of infection occurred within one month.MethodsIn 38 lung transplant recipients, deep airway secretions were collected through bronchofiberscope within two hours after the operation and were subjected to microbial identification by mNGS and microbial culture. The etiologic characteristics of lung transplant recipients were explored. Within one month, the infection status of recipients was monitored. The microbial species detected by mNGS were compared with the etiological agents causing infection within one month.ResultsThe detection rate of mNGS in the 38 airway secretions specimens was significantly higher than that of the microbial culture (P<0.0001). MNGS identified 143 kinds of pathogenic microorganisms; bacterial pathogens account for more than half (72.73%), with gram-positive and -negative bacteria occupying large proportions. Fungi such as Candida are also frequently detected. 5 (50%) microbial species identified by microbial culture had multiple drug resistance (MDR). Within one month, 26 (68.42%) recipients got infected (with a median time of 9 days), among which 10 (38.46%) cases were infected within one week. In the infected recipients, causative agents were detected in advance by mNGS in 9 (34.62%) cases, and most of them (6, 66.67%) were infected within one week (ultra-early). In the infection that occurred after one week, the consistency between mNGS results and the etiological agents was decreased.ConclusionBased on the mNGS-reported pathogens in airway secretions samples collected within two hours, the initial empirical anti-infection regimes covering the bacteria and fungi are reasonable. The existence of bacteria with MDR forecasts the high risk of infection within 48 hours after transplant, reminding us of the necessity to adjust the antimicrobial strategy. The predictive role of mNGS performed within two hours in etiological agents is time-limited, suggesting continuous pathogenic identification is needed after lung transplant.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Etiologic characteristics revealed by mNGS-mediated ultra-early and early microbiological identification in airway secretions from lung transplant recipients

Zhang,

Tang,

et al. 2023

Front. Immunol.

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“…Reports from over 100 cases of allografts transplanted from a donor with microbiologically proven meningitis with S. pneumoniae, N. meningitidis, or H. influenzae demonstrate no transmission with recipient-tailored antibiotics and no increase in graft failure or mortality. [31][32][33][34][35][36] One of these reports even documented an overall better survival rate in kidney recipients, in part explained by recipients' younger age and fewer comorbidities. 34 Allografts have been accepted from the donor as soon as 2-3 days of therapy and the duration of antibiotics for the recipient ranged from 6 to 10 days.…”

Section: Donor Cultures In the Prevention Of Bacterial And Fungal Ddismentioning

confidence: 99%

“…With or without documented bacteremia, donor community‐acquired bacterial meningitis has been on the other hand associated with a very low risk of DDI as long as the infection is documented and appropriate therapy is given. Reports from over 100 cases of allografts transplanted from a donor with microbiologically proven meningitis with S. pneumoniae , N. meningitidis , or H. influenzae demonstrate no transmission with recipient‐tailored antibiotics and no increase in graft failure or mortality 31–36 . One of these reports even documented an overall better survival rate in kidney recipients, in part explained by recipients' younger age and fewer comorbidities 34 .…”

Section: Introductionmentioning

confidence: 99%

Utility of deceased donor cultures in solid organ transplantation in preventing donor‐derived bacterial and fungal infectious diseases transmission

Boutin

Pouch

Ison

2023

Transplant Infectious Dis

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Deceased donor and organ perfusion fluid cultures are obtained in order to inform recipient antimicrobial management and therefore reduce the risk of donor‐derived bacterial and fungal infections. However, important heterogeneity exists in laboratory practice across organ procurement organizations and clinical management of culture results across transplant centers. While not standardized, the clinical approach to donors with positive bacterial and/or fungal cultures should be informed by the risk of donor‐derived infection (DDI) and the consequence of organ non‐utilization and account for potential unintended effects of antimicrobial use in the recipient. In this review, we summarize the literature on bacterial and fungal DDIs, describe the significance of positive cultures by anatomic site, and summarize current guidance on the management of positive cultures from donors or preservation fluids.

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“…Studies have examined outcomes when donor infections were only discovered after transplantation 3 or when highrisk donors were used for critically ill patients, with their permission, to avail of survival benefits. 4 The analysis of such data has established the safety of utilizing lungs from donors with positive respiratory cultures, those with bacterial meningitis, and those with hepatitis C. 2,5,6 These results have ultimately improved access to life-saving treatments for patients with end-stage lung diseases. 7 Current guidelines recommend obtaining cultures from donor allografts and blood, as infections at these sites may increase the risk of invasive infections after transplantation and may adversely affect graft function.…”

Section: Introductionmentioning

confidence: 99%

Donor blood cultures and outcomes after lung transplantation: a single‐center report

Hashim,

Saleh,

Abdulqawi

et al. 2023

Transplant Infectious Dis

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BackgroundTransplanting lungs from donors with positive blood cultures has not been shown to adversely affect survival. There is limited evidence for potential effects on other outcomes, such as hospital course, graft function, and transmission of infection.MethodsThis retrospective cohort study included adult patients who underwent lung‐only transplantation for the first time between March 2010 and December 2022. Outcomes of patients whose donors had positive blood cultures within 72 h of transplant were compared to patients whose donors had negative blood cultures.ResultsTwenty‐five (10.8%) of 232 donors had positive blood cultures, including a single, unexpected case with candidemia. The most commonly isolated bacteria were Enterobacter cloacae (n = 5), Klebsiella pneumoniae (n = 5), Acinetobacter baumannii (n = 3), Pseudomonas aeruginosa (n = 3), and Staphylococcus aureus (n = 3). Eleven donors had identical bacteria in their respiratory cultures. All patients who were transplanted from donors with positive blood cultures survived beyond 90 days. Positive donor blood cultures were not associated with longer hospital stay, in‐hospital complications, acute cellular rejection, or the achievement of 80% predicted forced expiratory volume in the first second. Probable transmission of donor bacteremia occurred in only two cases (both with S. aureus). These two donors had positive respiratory cultures with the same organism.ConclusionThe study did not find an increased risk of adverse events when transplanting lungs from donors with positive blood cultures. Allograft cultures may be more predictive of the risk of transmitting infections. image

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Bacterial meningitis as a cause of death in lung transplant donors: Early outcomes in recipients

Abstract: In our study, lung transplantation from increased risk donors with bacterial meningitis was not associated with an increased risk of early infectious complications in recipients. Donors with bacterial meningitis should be considered for lung donation and may expand the donor pool safely.

Cited by 8 publications

References 22 publications

Etiologic characteristics revealed by mNGS-mediated ultra-early and early microbiological identification in airway secretions from lung transplant recipients

Etiologic characteristics revealed by mNGS-mediated ultra-early and early microbiological identification in airway secretions from lung transplant recipients

Utility of deceased donor cultures in solid organ transplantation in preventing donor‐derived bacterial and fungal infectious diseases transmission

Donor blood cultures and outcomes after lung transplantation: a single‐center report

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