Decreased Antibiotic Utilization After Sinus Surgery in Cystic Fibrosis Patients With Lung Transplantation

Abstract

Background Patients with cystic fibrosis (CF) who have undergone lung transplantation frequently require hospitalizations and antibiotic treatments for respiratory tract infections. Although endoscopic sinus surgery (ESS) improves sinonasal quality of life in CF patients, it is unclear if ESS offers additional benefit in terms of antibiotics for pulmonary infection, hospitalization, and pulmonary function. Objective To determine whether ESS impacts antibiotic use or hospitalizations for pulmonary indications or pulmonary function in CF patients after lung transplantation. Methods This is a single-institution retrospective study of all patients who underwent lung transplantation for CF from 2005 to 2017. Patients who underwent ESS at least 1 year after transplant were included. Paired bivariate analyses were performed to determine whether there was a difference in the frequency and length of hospitalizations for pulmonary indications, number of antibiotic courses (intravenous and oral) for pulmonary exacerbations, and forced expiratory volume in 1 second (FEV1) slope in the 6 months before versus after ESS. Perioperative antibiotics and hospitalizations were not included in the analyses. Least squares regression was utilized to analyze FEV1 trends. Results A total of 20 patients underwent 36 ESS during the study period. There was significantly higher antibiotic utilization in the 6 months before ESS (0.89 ± 1.03) compared to the 6 months after ESS (0.33 ± 0.53) ( P = .002). The frequency and length of hospitalizations, FEV1 slope, and FEV1 trend before and after ESS were not significantly different. Conclusion Our results suggest that ESS is associated with a reduction in the frequency of antibiotic utilization for respiratory tract infections in lung transplant recipients with CF. A prospective study is needed to investigate these relationships further.

Cystic fibrosis foundation consensus statements for the care of cystic fibrosis lung transplant recipients

“…[44][45][46] Observational studies assessing the utility of pre-or post-transplant sinus surgery on CFTLRs regardless of symptoms found no substantive impact on post-transplant outcomes including CLAD, graft re-infection, or survival. 43,[47][48][49][50][51][52] Evidence for the impact of sinus surgery on the reduction in microbial isolates from BAL in asymptomatic CFLTRs is mixed; some studies report decreases and others report no change. 43,48,50 CFLTRs with symptomatic CRS had sinus cultures that strongly correlated with BAL cultures, particularly for P aeruginosa, MRSA, and B cepacia complex.…”

“…53 For symptomatic CRS, endoscopic sinus surgery after lung transplantation resulted in fewer positive bacterial isolates from the allograft, fewer infections, and less antibiotic utilization in single center observational studies. 47,49,51,52,[54][55][56][57][58][59] The use of perioperative intravenous antibiotics in CFLTRs who undergo sinus surgery may be beneficial despite lack of evidence and therefore close coordination between otolaryngology, the CF team and the lung transplant team is necessary to determine the optimal timing and duration of treatment in relation to sinus surgery.…”

Evaluación pretrasplante en otorrinolaringología

“…Se ha reportado un amplio rango en la presencia de síntomas de RS que va del 20,6% al 62% 14 , alteración de la nasofibroscopía en el 73,5% y un 93,5% en la TC CPN. La discordancia entre endoscopía/TC y clínica puede deberse a la adaptación a los síntomas y desvaloración en comparación a otras manifestaciones más severas de la enfermedad 26 , por lo tanto, se recomienda realizar una TC en la evaluación de pacientes con FQ, aunque no existen estudios que demuestren que la conducta por imágenes en estos pacientes beneficie el resultado postrasplante y disminuya la mortalidad, siendo superior la endoscopía nasal para su estudio 18 . Se ha observado, además, que la CEF en pacientes trasplantados de pulmón, aumenta significativamente el volumen espiratorio forzado del primer segundo (VEF1) y disminuye el promedio de días de hospitalización debido a bronconeumonía de 32,82 a 5,41 días, en una serie de 16 pacientes en comparación a los 6 meses previos a la CEF 27 .…”

Levosimendan in lung transplant recipients on VA‑ECMO

“…Ранний послеоперационный период у реципиентов легких может сопровождаться осложнениями, наиболее частыми из которых являются: кровотечения, дисфункция трансплантата, несостоятельность бронхиальных анастомозов. По данным литературы, в 20-30% случаях после ТЛ развивается острое почечное повреждение (ОПП), с показаниями для проведения заместительной почечной терапии (ЗПТ), у 40% пациентов в раннем послеоперационном периоде регистрируются нейрокогнитивные расстройства [5][6][7][8]. Одним из наиболее грозных осложнений является развитие сердечнососудистой недостаточности.…”