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

Multidrug-resistant organisms in lung transplant: a narrative review

“…Unfortunately, data are still conflicting in the lung transplant population. Recently, Boscolo et al [ 10 ▪ ], investigating potential risk factors of perioperative MDR and/or ESBL-GN isolations, reported an ESBL-GN bacteria prevalence around 5% (nine out to 153 lung transplant recipients), predominantly from respiratory samples, and a similar survival rate between recipients affected by ESBL and MDR-GN pathogens.…”

“…On the contrary, P. aeruginosa is the leading cause of hospital-acquired pneumonia (HAP) occurring after lung transplant (up to 25% of cases) [ 35 ]. Finally, several items, such as prolonged hospital stay, lung graft and previous hospitalization have been identified as important risk factors for CRE colonization and/or infection in SOT and similarly in lung transplants [ 10 ▪ , 31 ].…”

“…Similar data have been reported for MDR and high-resistance bacteria, showing a not relevant risk of transmission to lung transplant recipients [ 48 ]. With regards to pretransplant recipient's colonization, it represents an important predictive factor for developing posttransplant infections, especially in recipients with CF [ 10 ▪ , 49 , 50 ]. However, the American guidelines for antimicrobial prophylaxis in surgery suggested the use of cefazolin for heart and lung transplantations, despite previous colonizations, and recommended adjusting antimicrobial therapy according to postoperative isolations and clinical data [ 51 ].…”

“…However, a worldwide survey, conducted in 180 lung transplant centres, surprisingly showed that almost all centres adjusted antibiotic therapies based on previous colonizations and in more than 70% of cases were prescribed antibiotics against GN-resistant bacteria, even without previous bronchial colonizations [ 51 ]. Boscolo et al [ 10 ▪ ] may help to better clarify this issue: previous recipient-related, but not donor-related, colonization is an independent predictor of isolation of MDR and ESBL-GN bacteria in lung transplant recipients, but not necessarily related to a subsequent severe infection. So, the use of a ‘modified’ surgical prophylaxis, based on broad-spectrum antimicrobial drugs, seems conflicting and not necessarily associated with a lower risk of MDR or ESBL GN bacteria isolation after lung transplant [ 1 , 10 ▪ , 51 ].…”

“…Noteworthy lung transplant recipients experienced posttransplant infections more frequently than other SOT patients, with an incidence of MDR bacteria ranging between 31 and 57% [ 9 ]. Moreover, recent data showed that lung transplant recipients with perioperative MDR bacterial infection recorded higher in-hospital mortality, estimated to be up to six times greater than in non-MDR lung transplant controls [ 10 ▪ ]. In fact, recipients undergoing lung transplant, for indications other than cystic fibrosis, have been shown to develop frequently perioperative pneumonia (35%), and often caused by MDR bacteria [ 8 ▪▪ , 11 ▪ , 12 ▪ ].…”