Incidence and risk factors for respiratory tract bacterial colonization and infection in lung transplant recipients

Abstract

To evaluate incidence of and risk factors for respiratory bacterial colonization and infections within 30 days from lung transplantation (LT). We retrospectively analyzed microbiological and clinical data from 94 patients transplanted for indications other than cystic fibrosis, focusing on the occurrence of bacterial respiratory colonization or infection during 1 month of follow-up after LT. Thirty-three percent of patients developed lower respiratory bacterial colonization. Bilateral LT and chronic heart diseases were independently associated to a higher risk of overall bacterial colonization. Peptic diseases conferred a higher risk of multi-drug resistant (MDR) colonization, while longer duration of aerosol prophylaxis was associated with a lower risk. Overall, 35% of lung recipients developed bacterial pneumonia. COPD (when compared to idiopathic pulmonary fibrosis, IPF) and higher BMI were associated to a lower risk of bacterial infection. A higher risk of MDR infection was observed in IPF and in patients with pre-transplant colonization and infections. The risk of post-LT respiratory infections could be stratified by considering several factors (indication for LT, type of LT, presence of certain comorbidities, and microbiologic assessment before LT). A wider use of early nebulized therapies could be useful to prevent MDR colonization, thus potentially lowering infectious risk.

Lung Volume Reduction Followed by Lung Transplantation in Emphysema—A Multicenter Matched Analysis

“…It showed that LVR was associated with a distinct airway microbiome both before and after LuTX. In comparison to other LuTX-indications COPD has a lower risk of bacterial infections ( 25 ). It was unexpected that the number of colonized patients were as high even before LuTX (LVRS: 42.3%; ELVR: 39.3%).…”

Multidrug-Resistant and Extended-Spectrum β-Lactamase Gram-Negative Bacteria in Bilateral Lung Transplant Recipients

“…To the best of our knowledge, the present study is the first investigation exclusively focused on bilateral LT recipients, without restrictions on previous colonization and considering a wide spectrum of culture samples. 2,4,11,21 These assumptions allowed us to investigate the overall incidence of MDR and ESBL GN bacteria and to study the effect of broad-spectrum antibiotics administered empirically in a homogeneous cohort of recipients, investigations that were not comparable with previous studies also enrolling patients undergoing monolateral LT. 10,13,15,16,25 Based on recent literature, the incidence of MDR after LT is unclear. Paglicci et al 21 retrospectively investigated a cohort of 94 LT procedures from 2001 through 2018 and reported a slightly lower incidence than ours (31%), but patients affected by cystic fibrosis had been excluded.…”

“…2,4,11,21 These assumptions allowed us to investigate the overall incidence of MDR and ESBL GN bacteria and to study the effect of broad-spectrum antibiotics administered empirically in a homogeneous cohort of recipients, investigations that were not comparable with previous studies also enrolling patients undergoing monolateral LT. 10,13,15,16,25 Based on recent literature, the incidence of MDR after LT is unclear. Paglicci et al 21 retrospectively investigated a cohort of 94 LT procedures from 2001 through 2018 and reported a slightly lower incidence than ours (31%), but patients affected by cystic fibrosis had been excluded. However, Tebano et al 4 reported a higher overall MDR incidence than ours (51%), but gram-positive bacteria and more than 70% of monolateral LT recipients were included.…”

“…MDR pathogens were defined by resistance to $ 1 agent in $ 3 antimicrobial classes, whereas ESBL bacteria were identified through enzymes able to hydrolyze extended spectrum cephalosporins. 5,13,[19][20][21] Patients were classified into two groups according to the presence (MDR and ESBL group) or absence (control participants) of MDR and ESBL GN bacteria within the first month after LT, and patients fulfilling Sepsis-3 Q8 criteria were classified as infected. 17,22 The following variables were collected from electronic health records (Table 1): (1) demographic data (age, sex, BMI); (2) comorbidities;…”

Risk factors of wound infection after lung transplantation: a narrative review

“…Study has shown that the BMI of organ recipients is a risk factor for surgical incision infection after lung transplantation, and the BMI of patients with infection is significantly higher than those without (21). The median BMI of lung transplant patients with surgical incision site infection was greater than 24 kg/m 2 (22).…”