Epidemiology and risk factors of multidrug‐resistant bacteria in respiratory samples after lung transplantation

Abstract

A large proportion of MDR bacteria are detected on respiratory invasive samples in LT patients, and the risk of their emergence is mainly determined by the previous exposure to broad-spectrum antibiotics and the length of ICU stay. Adequate treatment requires broad-spectrum empiric antibiotic therapy.

Effect of positive perioperative donor and recipient respiratory bacterial cultures on early post‐transplant outcomes in lung transplant recipients

“…found that risk factors for MDROs in respiratory samples after lung transplantation include bilateral LT, mechanical ventilation >3 days, ICU LOS >14 days, the presence of a tracheostomy, and exposure to broad‐spectrum antibiotics. They also observed an increase in MDROs within the first 4 weeks of ICU hospitalization, indicating a need for an evaluation of the appropriateness of empiric antibiotics.…”

“…This study did not capture whether the use of broad‐spectrum antibiotics early on, in a disease state that is prone to multiple infections, impacts drug resistance and what impact that might have on long‐term outcomes. A recent study by Tebano et al . found that risk factors for MDROs in respiratory samples after lung transplantation include bilateral LT, mechanical ventilation >3 days, ICU LOS >14 days, the presence of a tracheostomy, and exposure to broad‐spectrum antibiotics.…”

“…Given the literature on the use of broad‐spectrum antibiotics being a risk factor for MDROs in post‐LT patients, the increased likelihood of post‐LT patients developing multiple infections throughout the graft's lifespan that will require antibiotics, and the attempt to preserve antibiotic activity, this study also sought to assess whether a change in protocol for post‐LT patients was warranted based on local susceptibility data . Contrary with much of the available literature on common infectious organisms post lung transplantation, Pseudomonas aeruginosa only grew in 12 isolates from 10 different patients, all of which were susceptible to empiric ceftazidime . Unfortunately, in our population the susceptibilities of Pseudomonas aeruginosa to more narrow antibiotics were too low to change current practice.…”

“…This number is significantly more than a new community‐acquired pneumonia study by Self et al., which found the incidence of MRSA pneumonia over a 2.5‐year time‐period was only 0.7%. The Tebano et al . study, which was specific to LT patients in the ICU post lung transplantation up to the first 28 days, had an 11.4% incidence of MRSA.…”

Microbiological findings in bronchoalveolar lavage fluid from lung transplant patients in Sweden

“…The low prevalence of MDR bacteria in our study reflects that Sweden still has a favorable situation regarding antimicrobial resistance compared to most countries. In comparison, Kovatz et al described a MRSA prevalence of 25% in lung transplant patients in the first post‐operative year, and Tebano et al found MDR strains in respiratory samples in 90 of 179 lung transplanted patients (51%). In a recent publication, Rodrigo‐Troyano et al describes the serious threat posed by Gram‐negative MDR bacteria in respiratory infections.…”