Achromobacter spp. in a Cohort of Non-Selected Pre- and Post-Lung Transplant Recipients

Abstract

Achromobacter is an opportunistic pathogen that mainly causes chronic lung infections in cystic fibrosis (CF) patients and is associated with increased mortality. Little is known about Achromobacter spp. in the lung transplant recipient (LTXr) population. We aimed at describing rates of Achromobacter spp. infection in LTXr prior to, in relation to, and after transplantation, as well as all-cause mortality proportion in infected and uninfected LTXr. We included 288 adult LTXr who underwent lung transplantation (LTX) between 1 January 2010 and 31 December 2019 in Denmark. Bronchoalveolar lavage was performed at regular intervals starting two weeks after transplantation. Positive cultures of Achromobacter spp. were identified in nationwide microbiology registries, and infections were categorized as persistent or transient, according to the proportion of positive cultures. A total of 11 of the 288 LTXr had transient (n = 7) or persistent (n = 4) Achromobacter spp. infection after LTX; CF was the underlying disease in 9 out of 11 LTXr. Three out of the four patients, with persistent infection after LTX, also had persistent infection before LTX. The cumulative incidence of the first episode of infection one year after LTX was 3.8% (95% CI: 1.6–6.0). The incidence rates of transient and persistent infection in the first year after LTX were 27 (12–53) and 15 (5–37) per 1000 person-years of follow-up, respectively. The all-cause mortality proportion one year after LTX was 27% in the Achromobacter spp. infected patients and 12% in the uninfected patients (p = 0.114). Achromobacter spp. mainly affected LTXr with CF as the underlying disease and was rare in non-CF LTXr. Larger studies are needed to assess long-term outcomes of Achromobacter spp. in LTXr.

Current viewpoint on the epidemiology of nonfermenting Gram-negative bacterial strains

“…Preliminary findings apprise of the involvement of Achromobacter spp. in the all-cause mortality in lung transplant recipients [61]. On the other hand, Chryseobacterium spp.…”

“…Particularly, for critically ill patients any shift in the lung microbiome might expose mechanically patients to increased risk for lower respiratory tract infection with MDR pathogens [71 & ]. The clinical epidemiology of the emerging NFGNB from recent studies is summarized in Table 1 [45,46,61,70,.…”

“…The clinical epidemiology of the emerging NFGNB from recent studies is summarized in Table 1[45,46,61,70,72–97].…”

“…Summary of the clinical epidemiology of uncommon, emerging NFGNB from recent reports (2021-2023)[45,46,61,70, …”

Thoracic Ultrasound in Lung Transplantation—Insights in the Field

“…ALAD has a different etiology; however, immediate allograft dysfunction may develop almost in prolongation of the operative procedure, and in up to 25–50% of cases, the underlying cause relates to primary graft dysfunction (PGD), defined as an acute non-immune-mediated injury to the transplanted lung occurring within the first 72 h postoperatively and which is caused by a combination of ischemia, reperfusion, cold organ preservation, and pretransplant pulmonary hypertension [ 20 , 21 ]. Other early (>72 h) risk factors or conditions in the short-term post-LTx stage leading to ALAD comprise acute cellular rejection (ACR), mechanical abnormalities (anastomotic strictures, bronchomalacia, diaphragm paralysis, and pleural effusion, including hemothorax), pneumonia (viral, bacterial, and fungal infections), thromboembolic disease, anemia, and gastro-esophageal reflux [ 15 , 22 , 23 , 24 , 25 ]. In the immediate post-transplantation setting, the use of computed tomography (CT) and other radiological methods is often challenged by a sedated ICU patient with bandages, chest tubes, and catheters, and although TUS might be challenging, it has the advantage of a bedside approach.…”