Postoperative antimicrobials after lung transplantation and the development of multidrug‐resistant bacterial and <i><scp>C</scp>lostridium difficile</i> infections: an analysis of 500 non‐cystic fibrosis lung transplant patients

Whiddon, Alexandra R.; Dawson, Kyle L.; Fuentes, Amaris; Perez, Katherine K.; Peterson, Leif E.; Kaleekal, Thomas

doi:10.1111/ctr.12746

Cited by 14 publications

(12 citation statements)

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“…The right balance to prevent infection risk with limited side effects is not known. The duration of gram-positive antimicrobials has been described to increase the risk of MDR and Clostridioides difficile infection in an analysis of 500 non-cystic fibrosis lung transplant patients [10]. In our survey, some centers adapted and stopped antibiotic therapy as soon as possible if the results of the bacteriological screening in donor and recipient were negative and there was no sign of infection.…”

Section: Discussionmentioning

confidence: 94%

“…We observed different antibiotic strategies between non-colonization recipients and recipients colonized with MDR bacteria in our survey, even under similar clinical conditions. Indeed, the presence of MDR bacteria followed the direction of the highest "caution" and, as an example, longer antibiotic therapy and less de-escalation were the reported responses despite a well-known risk factor for multidrug-resistant (MDR) bacterial and Clostridioides difficile infections in longer therapy [10][11][12]. It is still debated whether MDR bacteria are more problematic than wild-type agents.…”

Section: Discussionmentioning

confidence: 99%

“…The management of antibiotics in such a context could be difficult, and strategies for decontamination and prolonged combination therapy are emerging [9]. Inversely, extended durations of broad-spectrum antimicrobials are a well-known risk factor for multidrugresistant (MDR) bacterial and Clostridioides difficile infections [10][11][12]. There are currently no formal recommendations to guide antimicrobial selection in this specific context of lung transplant surgery [13].…”

Section: Introductionmentioning

confidence: 99%

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Worldwide clinical practices in perioperative antibiotic therapy for lung transplantation

et al. 2020

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Background: Infection is the most common cause of mortality within the first year after lung transplantation (LTx). The management of perioperative antibiotic therapy is a major issue, but little is known about worldwide practices. Methods: We sent by email a survey dealing with 5 daily clinical vignettes concerning perioperative antibiotic therapy to 180 LTx centers around the world. The invitation and a weekly reminder were sent to lung transplant specialists for a single consensus answer per center during a 3-month period. Results: We received a total of 99 responses from 24 countries, mostly from Western Europe (n = 46) and the USA (n = 34). Systematic screening for bronchial recipient colonization before LTx was mostly performed with sputum samples (72%), regardless of the underlying lung disease. In recipients without colonization, antibiotics with activity against gram-negative bacteria resistant strains (piperacillin / tazobactam, cefepime, ceftazidime, carbapenems) were reported in 72% of the centers, and antibiotics with activity against methicillin-resistant Staphylococcus aureus (mainly vancomycin) were reported in 38% of the centers. For these recipients, the duration of antibiotics reported was 7 days (33%) or less (26%) or stopped when cultures of donor and recipients were reported negatives (12%). In recipients with previous colonization, antibiotics were adapted to the susceptibility of the most resistant strain and given for at least 14 days (67%). Conclusion: Practices vary widely around the world, but resistant bacterial strains are mostly targeted even if no colonization occurs. The antibiotic duration reported was longer for colonized recipients.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Worldwide clinical practices in perioperative antibiotic therapy for lung transplantation

et al. 2020

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“…Several studies in lung transplant recipients have demonstrated increased incidence of MDROs and Clostridioides difficile due to longer courses of broad-spectrum antibiotics. 21,22 One study noted 34% of non-Cystic Fibrosis lung transplant recipients developed an MDRO infection and 6% developed Clostridioides difficile infection within 90 days of postoperative antibiotics. 21 The benefits of prolonged duration of perioperative antibiotics should be weighed against these additional risks.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of short vs long‐course perioperative antibiotics in lung transplant recipients with donor positive respiratory cultures

Groff

Reed

Coe

et al. 2020

Transplant Infectious Dis

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Lung transplantation is the only definitive treatment for patients with end-stage lung diseases. Despite numerous advancements in transplantation, infection remains the most common complication after lung transplantation. Risk factors for infection post-lung transplantation include donor-derived bacterial transmission, lung allograft exposure to the external environment, diminished cough reflex, abnormal mucociliary clearance, interrupted lymphatic drainage, and immunosuppression. 1Perioperative infections can have short and long-term sequelae including increased rates of acute and chronic lung allograft rejection, impaired graft function, and increased mortality. [2][3][4] To decrease the risk of donor-derived bacterial infections, transplant centers utilize extended courses of perioperative antibiotics in the setting of positive donor cultures. 5 However, duration of perioperative antibiotic therapy remains controversial with reported treatment durations ranging from 7 to 14 days. [5][6][7][8][9] Lack of formal

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“…Infekce Clostridium difficile je častou komplikací v čas ném období po LuTx při imunosupresivní léčbě a potrans plantační antibiotické profylaxi a postihuje až 6 % příjemců v prvních 90 dnech po LuTx [42].…”

Section: Tuberkulózaunclassified

The complications after lung transplantation

Jakubec¹,

Žůrková²,

Hajdová³

et al. 2017

Vnitř Lék

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Transplantace plic (LuTx) je významným léčebným postu pem pro vybranou skupinu pacientů v terminálním stadiu řady plicních onemocnění, který jim může přinášet vý razné zlepšení kvality života a dlouhodobé přežití. Od prv ních úspěšných LuTx v 80. letech 20. století dochází ke stá lému každoročnímu zvyšování počtu LuTx, který v roce 2012 přesáhl již číslo 3 700 ročně [1]. Medián přežití dospě lých po LuTx dosáhl 5,7 roku v roce 2014, ještě lepší pře žití je v případě oboustranných plicních transplantací, kde dosahuje 7 let oproti jednostranným transplantacím s mediánem přežití 4,5 roku [1]. S rozvojem chirurgických a transplantačních technik jsou dnes pro přežití pacientů limitující z velké části nikoliv časné perioperační kompli kace, ale spíše komplikace objevující se v pozdější době od LuTx. Tyto komplikace můžeme dělit do několika skupin.Jsou to rejekční stavy, infekční komplikace, nádory, nein fekční plicní komplikace a mimoplicní komplikace. RejekceZásadním problémem transplantací zůstávají přes po kroky v imunosupresivní terapii rejekční stavy. Může se jednat o hyperakutní, akutní (humorální, celulární) nebo chronickou rejekci. Hyperakutní rejekceHyperakutní rejekce se rozvíjí během minut až hodin po LuTx a je způsobená HLA donor specifickými protilátkami příjemce. Dochází k hypoxemii, edému plic s difuzními opacitami na skiagramu hrudníku. Dnes se jedná o vzácný stav kvůli zavedení předtransplantačního screeningu HLA protilátek u příjemce.

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Postoperative antimicrobials after lung transplantation and the development of multidrug‐resistant bacterial and Clostridium difficile infections: an analysis of 500 non‐cystic fibrosis lung transplant patients

Abstract: One-third (34%) of non-CF lung transplants develop MDR infections and 6% develop CDI within 90 d of postoperative antimicrobials. The duration of Gram-positive antimicrobials may increase the risk of MDR/CDI, while early transfer from the ICU may have a protective effect.

Cited by 14 publications

References 24 publications

Worldwide clinical practices in perioperative antibiotic therapy for lung transplantation

Worldwide clinical practices in perioperative antibiotic therapy for lung transplantation

Effectiveness of short vs long‐course perioperative antibiotics in lung transplant recipients with donor positive respiratory cultures

The complications after lung transplantation

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