Bacterial and Fungal Pneumonias After Lung Transplantation

Campos, Sílvia Vidal; Caramori, Marlova Luzzi; Teixeira, Ricardo Rodrigues; Afonso, José Eduardo; Carraro, Rafael Medeiros; Strabelli, Tânia Mara Varejão; Samano, Marcos Naoyuki; Pêgo-Fernandes, Paulo Manuel; Jatene, Fábio Biscegli

doi:10.1016/j.transproceed.2008.02.049

Cited by 81 publications

(84 citation statements)

References 6 publications

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“…In contrast, no pneumococcal-related pneumonia events were identifi ed in this cohort of LT recipients. Similar results were reported by Campos et al 14 in 108 episodes of pneumonia in LT recipients, where P aeruginosa was isolated in 33.3% of the patients and S aureus was isolated in 26.8%. Our study results add to the literature highlighting antimicrobial resistance patterns observed in patients with HCAP or HAP/VAP, with higher rates of MDR pathogens observed in the HAP/VAP group.…”

Section: Discussionsupporting

confidence: 90%

Understanding the Concept of Health Care-Associated Pneumonia in Lung Transplant Recipients

Palacio

Reyes

Levine

et al. 2015

Chest

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Section: Discussionsupporting

confidence: 90%

Understanding the Concept of Health Care-Associated Pneumonia in Lung Transplant Recipients

Palacio

Reyes

Levine

et al. 2015

Chest

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“…There were 290 episodes of acute rejection at a median of 147 days (IQR, 40-409) after transplant in 152 individuals (58%). The median number of bronchoscopies was not greater in those with BOS or any episode of acute rejection compared with those without either, and there was no significant difference in number of bronchoscopies between those with and without pseudomonas or aspergillus isolation (nine bronchoscopies [IQR, [7][8][9][10][11] vs. eight bronchoscopies [IQR, [6][7][8]; P ¼ 1, Wilcoxon rank-sum test). Bronchoscopy specimens were obtained for a mixture of surveillance (61%), clinical (29%), follow-up for abnormal findings (8%), and undocumented (2%) indications.…”

Section: Lung Transplant Patient Population and Clinical Outcomesmentioning

confidence: 93%

“…However, the most commonly isolated pathogens after lung transplantation are bacteria, broadly separated into gram-negative and gram-positive organisms (5)(6)(7)(8). The gram-negative Pseudomonas aeruginosa is the most frequently isolated bacterium after lung transplantation (5)(6)(7)(9)(10)(11)(12). Moreover, bacterial pulmonary infections have been associated with increased bronchoalveolar lavage fluid (BALF) levels of inflammatory markers, including the glutamic acid-leucine-arginine-positive (ELR 1 ) CXC chemokine IL-8 (CXCL8) (13)(14)(15)(16).…”

mentioning

confidence: 99%

Interaction between Pseudomonas and CXC Chemokines Increases Risk of Bronchiolitis Obliterans Syndrome and Death in Lung Transplantation

Gregson

Wang

Weigt

et al. 2013

Am J Respir Crit Care Med

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Rationale: Pseudomonas aeruginosa is the most commonly isolated gram-negative bacterium after lung transplantation and has been shown to up-regulate glutamic acid-leucine-arginine-positive (ELR 1 ) CXC chemokines associated with bronchiolitis obliterans syndrome (BOS), but the effect of pseudomonas on BOS and death has not been well defined. Objectives: To determine if the influence of pseudomonas isolation and ELR 1 CXC chemokines on the subsequent development of BOS and the occurrence of death is time dependent. Methods: A three-state model was developed to assess the likelihood of transitioning from lung transplant (state 1) to BOS (state 2), from transplant (state 1) to death (state 3), and from BOS (state 2) to death (state 3). This Cox semi-Markovian approach determines state survival rates and cause-specific hazards for movement from one state to another. Measurements and Main Results: The likelihood of transition from transplant to BOS was increased by acute rejection, CXCL5, and the interaction between pseudomonas and CXCL1. The pseudomonas effect in this transition was due to infection rather than colonization. Movement from transplant to death was facilitated by pseudomonas infection and single lung transplant. Transition from BOS to death was affected by the length of time in state 1 and by the interactions between any pseudomonas isolation and CXCL5 and aspergillus, either independently or in combination. Conclusions: Our model demonstrates that common post-transplantation events drive movement from one post-transplantation state to another and influence outcomes differently depending upon when after transplantation they occur. Pseudomonas and the ELR 1 CXC chemokines may interact to negatively influence lung transplant outcomes.Keywords: transplantation; lung; BOS; pseudomonas; chemokine Lung transplantation is a life-saving procedure for end-stage lung disease. Long-term success is limited by the high incidence of chronic lung allograft dysfunction, predominantly due to bronchiolitis obliterans syndrome (BOS). Acute rejection is perhaps the most widely recognized event to increase the risk of chronic lung allograft dysfunction. There is expanding evidence that a variety of infections increase the chances of developing BOS. Fungal pneumonia or colonization (1, 2) and viral pneumonitis (1, 3, 4) are among infectious conditions shown to increase the risk of BOS. However, the most commonly isolated pathogens after lung transplantation are bacteria, broadly separated into gram-negative and gram-positive organisms (5-8). The gram-negative Pseudomonas aeruginosa is the most frequently isolated bacterium after lung transplantation (5-7, 9-12). Moreover, bacterial pulmonary infections have been associated with increased bronchoalveolar lavage fluid (BALF) levels of inflammatory markers, including the glutamic acid-leucine-arginine-positive (ELR 1 ) CXC chemokine IL-8 (CXCL8) (13-16). Prior studies have suggested that pseudomonas may influence the development of BOS by de novo colonization after lung transp...

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“…(Kramer et al 1993) This opportunistic infection has a higher incidence in CF patients and has been estimated to be responsible for up to 33% of pneumonias in all transplant recipients. (Aguilar-Guisado et al 2007;Campos et al 2008) P. aeruginosa airway infection prior to transplant does not appear to demonstrate a predictive relationship for chronic rejection. However, this is not the case for colonization in the post-operative period.…”

Section: Bacterial Infectionmentioning

confidence: 95%