The Diagnosis of Pneumonia in Renal Transplant Recipients Using Invasive and Noninvasive Procedures

Chang, Gee‐Chen; Wu, Chieh‐Liang; Pan, Shin-Hung; Yang, Tsung‐Ying; Chin, Chung-Shih; Yang, Yun-Chiu; Chiang, Chi‐Der

doi:10.1378/chest.125.2.541

Cited by 68 publications

(40 citation statements)

References 33 publications

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“…The etiology of pneumonia in kidney transplant recipients is diverse. As seen in previous studies, bacterial pneumonia was the most frequent etiology in our kidney transplant recipients population and was microbiologically diagnosed in 22 episodes (20%) (11,12). Similar to other studies, the most frequent bacterial etiologies of pneumonia reported in KT patients were Haemophilus influenza and Pseudomonas aeruginosa (11,13).…”

Section: Discussionsupporting

confidence: 88%

Epidemiology and Clinical and Radiographic Characteristics of Pneumonia in Kidney Transplant Recipients; 24-Year Experience

Dizdar¹,

Akalın²

2017

Turk Neph Dial Transpl

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OBJECTIVE: Pneumonia increases morbidity and mortality in kidney transplant (KT) recipients. This study aimed to investigate characteristics of pneumonias in KT recipients by focusing on clinical and radiographic findings and diagnostic methods over a long study period. MATERIAL and METHODS:The medical records of kidney transplant recipients who had a diagnosis of pneumonia from 1988 to 2011 were reviewed retrospectively. RESULTS:Among 406 consecutive KT recipients, 20% had pneumonia during the study period and total 111 episodes of pneumonia developed in these patients. Fifty-six percent of the pneumonias were community acquired and 44% nosocomial. Bacterial infections were the most common cause (20%) and 13 (12%) of the episodes were polymicrobial. Antibiotic usage in the last three months was significantly more common in fungal pneumonia episodes than others. Bronchoscopy had the highest final overall diagnostic yield.CONCLUSION: Community-acquired pneumonia was more common, but it showed a more benign clinical course. Bacterial pneumonia was the most common cause, but polymicrobial infection was present in a significant number of KT recipients. Fungi can invade KT recipients, in particular, patients in the interval of 1-6 month after transplantation and patients who have used antibiotics in the last three months.KEy wORDS: Pneumonia, Kidney transplantation, Radiography, Physical examination, Nosocomial Öz AMAÇ: Pnömoni böbrek nakil hastalarında morbidite ve mortaliteyi artırır. Çalışmada böbrek nakil hastalarında uzun bir zaman diliminde klinik ve radyografik bulgular ve tanısal yöntemlere odaklanarak pnömonilerin özellikleri incelendi. GEREÇ ve yÖNTEMLER:Retrospektif olarak 1988 ile 2011 yılları arasında pnömoni tanısı almış böbrek nakil hastalarının bilgileri incelendi. BULGULAR:Çalışma süresi içerisinde böbrek nakli yapılmış 406 hastanın %20'sinde pnömoni gelişti. Toplam pnömoni atak sayısı 111 idi. Pnömoni ataklarının %56'sı toplum, %44'ü nazokomial kökenli idi. Bakteriyel enfeksiyonlar en sık nedendi (%20) ve atakların 13'ü (%12) polimikrobiyaldi. Son üç ay içinde antibiyotik kullanımı fungal pnömonilerde daha sıktı. Bronkoskopi en yüksek tanı koydurucu yöntemdi. SONUÇ:Böbrek nakli hastalarında toplum kökenli pnömoniler daha sıktır ve daha iyi bir seyre sahiptir. Bakteriyel pnömoniler en sık neden olmasına rağmen polimikrobiyal enfeksiyonlarda oldukça sıktır. Fungal pnömoniler özellikle nakilden sonraki 1-6 aylık dönemde sıktır ve son üç ay içinde antibiyotik kullanan hastalarda daha sık görülür.

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Section: Discussionsupporting

confidence: 88%

Epidemiology and Clinical and Radiographic Characteristics of Pneumonia in Kidney Transplant Recipients; 24-Year Experience

Dizdar¹,

Akalın²

2017

Turk Neph Dial Transpl

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“…11 Pneumonia-related frequency of death in the present study was similar to previous studies (15% to 29%). 8,16 Although male sex, history of diabetes mellitus, and cigarette smoking were significant risk factors for death in the univariate analysis in the present study, they were not significant risk factors in the multivariate analysis. Risk of death was increased by use of antibiotics in the previous 3 months (19-fold), low albumin (4.1-fold), and high Creactive protein (1.1-fold).…”

Section: Discussioncontrasting

confidence: 56%

Untitled

2014

Exp Clin Transplant

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Objectives: Pneumonia is an important cause of morbidity and mortality in recipients of solid-organ transplant. We aimed to determine risk factors for development of pneumonia and associated deaths in kidney transplant recipients. 31%]). In multivariate analysis, significant risk factors associated with pneumonia episodes were older age, hypertension, cardiac disease, history of acute graft rejection, and not using everolimus/mycophenolate mofetil/prednisolone protocol. There were 28 episodes that resulted in death (25%), including 20 nosocomial episodes (71%). In multivariate analysis, significant risk factors associated with death from pneumonia episodes were antibiotic use in the previous 3 months, high C-reactive protein, and low albumin. Cutoff values for increased risk of death from pneumonia included C-reactive protein > 10 mg/dL and procalcitonin > 8.8 ng/mL. Conclusions: Recipients of kidney transplant may be at risk for pneumonia and associated death. Nosocomial pulmonary infections may be associated with marked morbidity and mortality in kidney transplant recipients.

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“…Atypical patterns are often found in patients with diabetes or in renal transplant recipients [30]. However, REICHENBERGER et al [31] have previously reported a very low incidence of TB in immunocompromised patients.…”

Section: Discussionmentioning

confidence: 99%

Value of smear and PCR in bronchoalveolar lavage fluid in culture positive pulmonary tuberculosis

Tueller

Chhajed²,

Buitrago-Téllez³

et al. 2005

Eur Respir J

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At present, further investigations are needed in patients with suspected pulmonary tuberculosis (TB) and either negative sputum smear or without sputum. The aim of the present study was to analyse the yield of bronchoalveolar lavage fluid (BALF) smear and PCR in patients with confirmed pulmonary TB.Patients with a positive culture for Mycobacterium tuberculosis complex in sputum or BALF were analysed over 5 yrs.In total, 90 out of 230 (39%) patients with culture-positive pulmonary TB had a positive sputum smear, and 120 patients underwent bronchoscopy. BALF smear was positive in 56 (47%), BALF PCR in 93 (78%) patients, and BALF smear and/or PCR was positive in 83%. In total, 71 patients who underwent bronchoscopy and had complete clinical records were further analysed. BALF (smear or Mycobacterium tuberculosis complex-PCR) allowed a rapid diagnosis in 10 (59%) out of 17 patients who had a negative sputum smear, and 49 (91%) out of 54 patients without sputum production. Of these 71 patients, 12 (17%) were only culture positive. Rapid diagnosis of pulmonary TB by smear and/or PCR was made in 190 out of 210 patients (90%) in sputum or BALF.In conclusion, combined use of bronchoalveolar lavage fluid smear and Mycobacterium tuberculosis complex-PCR has a good diagnostic yield in patients with sputum smear-negative tuberculosis or without sputum production.

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The Diagnosis of Pneumonia in Renal Transplant Recipients Using Invasive and Noninvasive Procedures

Cited by 68 publications

References 33 publications

Epidemiology and Clinical and Radiographic Characteristics of Pneumonia in Kidney Transplant Recipients; 24-Year Experience

Epidemiology and Clinical and Radiographic Characteristics of Pneumonia in Kidney Transplant Recipients; 24-Year Experience

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Value of smear and PCR in bronchoalveolar lavage fluid in culture positive pulmonary tuberculosis

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