Morbidity and mortality related to pneumonia and TRACHEOBRONCHITIS in ICU after lung transplantation

Abstract

BackgroundBacterial respiratory infections (BRI) are major complications contributing to increased morbidity and mortality after lung transplantation (LT). This study analyzed epidemiology and outcome of 175 consecutive patients developing BRI in ICU after LT between 2006 and 2012.MethodsThree situations were described: colonization determined in donors and recipients, pneumonia and tracheobronchitis during the first 28 postoperative days. Severity score, demographic, bacteriologic and outcome data were collected.Results26% of donors and 31% of recipients were colonized. 92% of recipients developed BRI, including at least one episode of pneumonia in 19% of recipients. Only 21% of recipients developed BRI with an organism cultured from the donor’s samples, while 40% of recipients developed BRI with their own bacteria cultured before LT. Purulent sputum appears to be an important factor to discriminate tracheobronchitis from pneumonia. When compared to patients with tracheobronchitis, those with pneumonia had longer durations of mechanical ventilation (13 [3–27] vs 3 [29], p = 0.0005) and ICU stay (24 [16–34] vs 14 [9-22], p = 0.002). Pneumonia was associated with higher 28-day (11 (32%) vs 9 (7%), p = 0.0004) and one-year mortality rates (21 (61%) vs 24 (19%), p ≤ 0.0001).ConclusionsThese data confirm the high frequency of BRI right from the early postoperative period and the poor prognosis of pneumonia after LT.

Worldwide clinical practices in perioperative antibiotic therapy for lung transplantation

“…Donors are also potential sources of infection and donor-derived infections in lung transplant recipients have been reported in 5-20% of cases, some with fatal outcomes [22][23][24][25], and justify antibiotic therapy against GNB-resistant strains, especially since donor lung criteria were extended to marginal donors, including donors with bronchial secretions and with prolonged mechanical ventilation [26][27][28]. Antibiotics may allow a remarkable decrease in donor-derived infections (from 5.7 to 2.9%) in a single-center study after performing tailored antibiotic treatment even when these antibiotics are given as nebulized administration [25].…”

<p>The Effects of Type 2 Diabetes and Postoperative Pneumonia on the Mortality in Inpatients with Surgery</p>

“…13 Several studies identify postoperative pneumonia as a predictor of short-term and long-term mortality after surgery. [14][15][16][17][18][19] Is there a difference in the outcomes of postoperative pneumonia between patients with and without T2DM?…”

Dornase alfa during lower respiratory tract infection post-lung transplantation: a randomized controlled trial

“…As a result of infection control policies, we were unable to include patients isolated with suspected or confirmed viral respiratory infection, although dornase alfa would not typically be indicated in acute inflammatory syndromes in the absence of abnormal secretions. There is scope to pursue further research in stable outpatients or inpatients with conclusive diagnoses of bacterial LRTI, during which dornase alfa may be more effective in the presence of purulent sputum . Results should be interpreted acknowledging that this was a single center trial conducted in patients beyond the 2‐month early postoperative recovery period.…”