Burkholderia cepacia, cystic fibrosis and outcomes following lung transplantation: experiences from a single center in Brazil

Carraro, Danila de Souza; Carraro, Rafael Medeiros; Campos, Sílvia Vidal; Iuamoto, Leandro Ryuchi; Braga, Karina Andrighetti de Oliveira; Oliveira, Léa Campos de; Sabino, Éster Cerdeira; Rossi, Flávia; Pêgo-Fernandes, Paulo Manuel

doi:10.6061/clinics/2018/e166

Cited by 10 publications

(4 citation statements)

References 19 publications

(20 reference statements)

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“…A major challenge when transplanting CF patients is the presence of microbial pathogens at the time of transplant, increasing the risk for infectious complications in the early post-operative period as well as later recurrence in the transplanted lung in part due to immunosuppressants [ 2 , 3 , 4 , 5 ]. This has been shown for specific pathogens like Burkholderia cepacia complex (BCC) [ 6 ], which is a risk factor for developing pneumonia [ 7 ] and death in the early post-transplant period where immunosuppression is at maximum [ 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Bacterial Re-Colonization Occurs Early after Lung Transplantation in Cystic Fibrosis Patients

Holm

Schultz

Johansen

et al. 2021

JCM

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Most cystic fibrosis (CF) patients referred for lung transplantation are chronically infected with Gram-negative opportunistic pathogens. It is well known that chronic infections in CF patients have a significant impact on lung-function decline and survival before transplantation. The rate and timing of re-colonization after transplantation have been described, but the impact on survival after stratification of bacteria is not well elucidated. We did a single-center retrospective analysis of 99 consecutive CF patients who underwent lung transplantation since the beginning of the Copenhagen Lung Transplant program in 1992 until October 2014. Two patients were excluded due to re-transplantation. From the time of CF diagnosis, patients had monthly sputum cultures. After transplantation, CF-patients had bronchoscopy with bronchoalveolar lavage at 2, 4, 6 and 12 weeks and 6, 12, 18 and 24 months after transplantation, as well as sputum samples if relevant. Selected culture results prior to and after transplantation were stored. We focused on colonization with the most frequent bacteria: Pseudomonas aeruginosa (PA), Stenotrophomonas maltophilia (SM), Achromobacter xylosoxidans (AX) and Burkholderia cepacia complex (BCC). Pulsed-field gel electrophoresis (PFGE) was used to identify clonality of bacterial isolates obtained before and after lung transplantation. Time to re-colonization was defined as the time from transplantation to the first positive culture with the same species. Seventy-three out of 97 (75%) had sufficient culture data for analyses with a median of 7 (1–91) cultures available before and after transplantation. Median colonization-free survival time was 23 days until the first positive culture after transplantation. After 2 years, 59 patients (81%) were re-colonized, 33 (48.5%) with PA, 7 (10.3%) with SM, 12 (17.6%) with AX, and 7 (10.3%) with BCC. No difference in survival was observed between the patients colonized within the first 2 years and those not colonized. Re-colonization of bacteria in the lower airways occurred at a median of 23 days after transplantation in our cohort. In our patient cohort, survival was not influenced by re-colonization or bacterial species.

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Section: Introductionmentioning

confidence: 99%

Bacterial Re-Colonization Occurs Early after Lung Transplantation in Cystic Fibrosis Patients

Holm

Schultz

Johansen

et al. 2021

JCM

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“…For example, Burkholderia cenocepacia has long been considered an absolute contraindication to LTX, and still is in most centres. However, some centres will consider listing a patient who has been culture negative for a period of time, following treatment [ 2 , 3 ].…”

Section: Whom Should We List?mentioning

confidence: 99%

Controversies and emerging topics in lung transplantation

Abelson

Glanville

2018

Breathe

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Lung transplantation provides a realistic hope of improved survival and enhanced quality of life. However, outcomes can be disappointing, meaning many decisions are highly controversial. Practice is largely based on expert opinion and there is a dearth of high-level evidence. Not surprisingly, this leads to centre-specific practices that may vary considerably in controversial areas. The aim of this review, therefore, is to explore some of those domains and present the available evidence. As the science of lung transplantation approaches its fifth decade, we are only now reaching a critical mass of clinicians and scientific researchers to enable adequately powered studies to assist in informing our approach to some of these controversies.Key pointsLung transplantation remains an art, combining experience with evidence.Clinicians need evidence to guide them on a myriad of questions, from candidate selection and listing, to organ donor acceptance, immunosuppression and chronic allograft dysfunction.Chronic lung allograft dysfunction pathogenesis deserves further detailed study.Educational aimsTo illustrate the spectrum of controversial areas in lung transplantation including whom to list, which organs can be used and for whom, immune suppression and infection prophylaxis, and causes and phenotypes of chronic lung allograft dysfunction.To inspire clinicians to always ask questions and help collect the evidence we need to inform decision making.

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“…Infections caused by these bacteria can be difficult to treat because of their significant antibiotic resistance (6,7). Although the prevalence of colonization with Burkholderia cepacia complex is relatively low in CF patients, it is important as some genomovars of this bacterium can reduce survival after lung transplantation (8). Stenotrophomonas maltophilia is another bacterial species that commonly colonizes the respiratory tract of CF patients.…”

Section: Introductionmentioning

confidence: 99%

Molecular Identification of Gram-Negative Bacteria in Respiratory Samples of Cystic Fibrosis Patients from a Children Referral Hospital in Tehran

Azimi

Ghanaiee

Shirdust

et al. 2019

Arch Pediatr Infect Dis

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Background: Gram-negative bacteria are a major cause of pulmonary infection in patients with cystic fibrosis (CF). Objectives: The study aimed to conduct the molecular identification of Gram-negative bacterial flora causing pulmonary infection in children with CF. Methods: In this study, sputum samples were taken from 64 CF children undergoing treatment as outpatients or inpatients at a referral children's hospital in Tehran. The PCR technique was used to detect the presence of Gram-negative bacteria, namely Pseudomonas spp., Acinetobacter baumannii, Stenotrophomonas maltophilia, and Burkholderia cepacia. Results: All samples were positive for 16srRNA. Pseudomonas spp. and A. baumannii were detected in 47% and 14% of the studied samples, respectively. Co-colonization by Pseudomonas spp. and A. baumannii was observed in three (5%) samples. Conclusions: According to this survey, Pseudomonas spp. were the most prevalent Gram-negative bacteria isolated from CF patients with pulmonary infection by molecular assays.

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Burkholderia cepacia, cystic fibrosis and outcomes following lung transplantation: experiences from a single center in Brazil

Cited by 10 publications

References 19 publications

Bacterial Re-Colonization Occurs Early after Lung Transplantation in Cystic Fibrosis Patients

Bacterial Re-Colonization Occurs Early after Lung Transplantation in Cystic Fibrosis Patients

Controversies and emerging topics in lung transplantation

Molecular Identification of Gram-Negative Bacteria in Respiratory Samples of Cystic Fibrosis Patients from a Children Referral Hospital in Tehran

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