Routine Donor and Recipient Screening for Mycoplasma hominis and Ureaplasma Species in Lung Transplant Recipients

Abstract

Background Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum may cause post-transplant infections in lung transplant recipients. We evaluated routine pre-transplant screening for these Mollicutes. Methods We retrospectively reviewed records of lung transplant recipients at our tri-site institution from 01/01/2015 to 11/15/2019. M. hominis, and/or Ureaplasma PCR were performed on pre-transplant recipient urine specimens and donor bronchial swabs at the time of transplantation. Development of Mollicute infection and hyperammonemia syndrome (HS) was recorded. Results 268 patients underwent lung transplantation during the study period of which 105 were screened with at least one Mollicute PCR. 12 (11%) screened positive; 10 donors, 1 recipient and 1 both. Among positive donors, 3 were positive for M. hominis, 5 for U. urealyticum, and 4 for U. parvum. Preemptive therapy included doxycycline, levofloxacin and/or azithromycin administered for 1 to 12 weeks. Despite therapy, 1 case of M. hominis mediastinitis and 1 case of HS associated with Ureaplasma infection occurred, both donor-derived. Of those screened prior to transplant, cases with positive screening were more likely (P < 0.05) to develop Mollicute infection despite treatment (2/12, 17%) than those who screened negative (1/93, 1%). Conclusions Pre-transplant recipient urine screening had a low yield and was not correlated with post-transplant Mollicute infection, likely because most M. hominis and U. parvum/urealyticum infections in lung transplant recipients are donor-derived. Routine donor bronchus swab PCR for M. hominis, U. urealyticum and U. parvum followed by preemptive therapy did not obviously impact overall incidence of Mollicute infection or HS in this cohort.

Donor-derived infections in solid organ transplant recipients

“…On the basis of this growing evidence, routine lung donor screening of mollicutes followed by preemptive therapy should be considered at transplantation and has been incorporated by several international guidelines (https://freepub.edqm.eu/ publications/PUBSD-88/detail). The role of antimicrobial therapy in these cases is still unclear, but in recipients from lung donors with positive screening, we recommend a treatment, which may include typically a combination of a fluoroquinolone, a tetracycline, or a macrolide antibiotic, due to increasing reports of antibiotic resistance [34][35][36][37].…”

“…Routine donor lung screening for mollicutes has been found to have a prevalence of about 10%. Young age, female sex, and a history of high-risk behavior (mainly high-risk sexual practices) are well known risk factors of the donor [ 36 ].…”