Clinical outcome following lung transplantation in patients with cystic fibrosis colonised with Burkholderia cepacia complex: results from two French centres

Abstract

Background: Infection with Burkholderia cepacia complex (BCC) is a life threatening complication of cystic fibrosis (CF), often seen as a contraindication for lung transplantation. Methods: A long term retrospective study was conducted of all patients with CF undergoing lung transplants from January 1990 to October 2006 in two French centres allowing transplantation in patients colonised with BCC. Results: 22 of the 247 lung transplant patients with CF were infected with BCC (B cenocepacia genomovar III (n = 8), B multivorans genomovar II (n = 11), B vietnamiensis genomovar V (n = 2) and B stabilis genomovar IV (n = 1)). BCC colonisation was not associated with any significant excess mortality (HR 1.5, 95% CI 0.7 to 3.2; p = 0.58). However, early mortality rates tended to be higher in the BCC group than in the non-BCC group (3 month survival: 85% vs 95%, respectively; log rank p = 0.05). Univariate analysis showed that the risk of death was significantly higher for the eight patients infected with B cenocepacia than for the other 14 colonised patients (HR 3.2, 95% CI 1.1 to 5.9; p = 0.04). None of the other risk factors testedprimary graft failure, late extubation, septicaemia-had a significant effect. The 5 year cumulative incidence rate of bronchiolitis obliterans syndrome was not significantly higher in the BCC group than in the non-BCC group (38% vs 24%, respectively; p = 0.35). Conclusion: Our results suggest that BCC infection with a non-genomovar III organism may not be associated with excess mortality after lung transplantation in patients with CF and should not be seen as sufficient reason to exclude lung transplantation. However, colonisation with B cenocepacia remains potentially detrimental.Cystic fibrosis (CF) is the most common inherited lung disease. It frequently progresses to respiratory failure and death and the treatments currently available aim to slow progression through respiratory therapy, good nutritional support and the treatment of pulmonary exacerbations. In patients with end stage CF, lung transplantation may help to prolong survival and ensure that patients have an acceptable quality of life. Survival rates 1, 3 and 5 years after transplantation of 76%, 60% and 49%, respectively, have been reported. 1 Organ shortages have led some physicians to try to select the ''best candidates'' for lung transplantation.2 One of the criteria used in pretransplantation selection is the absence of infection with Burkholderia cepacia complex (BCC). This gram negative bacterium causes serious opportunistic infections and has emerged as a major pathogen in patients with CF, with the clinical outcome of infection varying from long term bronchial colonisation to life threatening necrotising pneumonia and sepsis, known as ''cepacia syndrome''. Global mortality rates for BCC colonisation may reach 50%, 3-9 depending on genomovar type. However, these rates were determined for patients who had not yet undergone transplantation. Conflicting results have been published concerning post-transplantation ...

Multidrug-resistant Gram-negative bacteria in solid organ transplant recipients with bacteremias

“…Two studies involving bacteremic or non-bacteremic SOT recipients with XDR Acinetobacter baumannii suggested that colistin-carbapenem combinations may result in improved clinical responses and survival, and may also limit the emergence of colistin resistance, with the durations of combination therapies ranging between 3 and 52 days [22,23]. In lung transplant recipients with MDR Pseudomonas aeruginosa infections, combination therapies included two or three different classes (beta-lactam + aminoglycoside ± fluoroquinolone) of antimicrobials for 10-14 days, and in non-lung SOT patients, shorter treatment durations (7-10 days) might be possible, depending on the infection site [56,58,59]. Combination therapies including piperacillin-tazobactam, carbapenems (except ertapenem), and/or trimethoprim-sulfamethoxazole should be favored for Achromobacter xylosoxidans infection [24,57].…”

Factors Influencing Acquisition of Burkholderia cepacia Complex Organisms in Patients with Cystic Fibrosis

“…Infection with B. cepacia complex organisms can result in increased mortality and morbidity, including "cepacia syndrome," and it has been associated with person-to-person transmission and poor outcomes following lung transplantation (1)(2)(3)(4)(5). Currently, the B. cepacia complex comprises 17 distinct species (6,7).…”

LUNG TRANSPLANTATION IN CYSTIC FIBROSIS PATIENT WITH CHRONIC AIRWAYS INFECTION OF BURKHOLDERIA CEPACIA (the first case in Russian Federation)

“…В мировой научной медицинской литературе до настоящего времени отсутствуют методические рекомендации или клинические обзоры по лече-нию данной группы пациентов после транспланта-ции легких, имеются лишь сообщения отдельных трансплантационных центров об удачных или не-удачных схемах послеоперационной антимикроб-ной терапии [13][14][15]. Успех лечения в нашем на-блюдении обусловлен, по-видимому, комбинацией агрессивной хирургической тактики, адекватной лекарственной терапии (применение больших доз противомикробных лекарственных средств с целью преодоления антибиотикорезистентности), редук-ции иммуносупрессии и применением гиперба-рической оксигенации (ГБО).…”