Incidence of nosocomial pneumonia and risk of recurrence after antimicrobial therapy in critically ill lung and heart–lung transplant patients

Abstract

Little is known about the resolution of symptoms of nosocomial pneumonia (NosoP) after lung and heart-lung transplantation. The aim of this study was to describe the clinical response to antimicrobial therapy in (ICU) patients with NosoP after lung or heart-lung transplantation. Between January 2008 and August 2010, 79 lung or heart-lung transplantations patients were prospectively studied. NosoPwas confirmed by quantitative cultures of bronchoalveolar lavage or endotracheal aspirates. Clinical variables, sequential organ failure assessment (SOFA) score, and radiologic score were recorded from start of therapy until day 9. Thirty-five patients (44%) experienced 64 episodes of NosoP in ICU. Fourteen patients (40%) had NosoP recurrence. Most frequently isolated organisms were Enterobacteriaceae (30%), Pseudomonas aeruginosa (25%), and Staphylococcus aureus (20%). Sequential organ failure assessment (SOFA) score improved significantly at day 6 and C-reactive protein level at day 9. SOFA and radiologic scores differed significantly between patients with and without NosoP recurrence at day 3 and 9. The ICU mortality rate did not differ between patients with and without NosoP recurrence, and free of NosoP (14.3%, 9.5%, 11.4%, respectively) (p = 0.91). Severities of illness and lung injury were the two major risk factors for NosoP recurrence. Occurrence of NosoP has no impact on ICU mortality.

Ventilator-associated respiratory infection following lung transplantation

“…Also in accordance with previous studies [10,38,39], pre-transplant colonisation was not associated with a higher incidence of ventilator-associated respiratory infection and patients with cystic fibrosis (despite the fact that they were all colonised, frequently by multidrug-resistant organisms) did not present more episodes of VAT or VAP than the rest of the population. The same was true for all the other underlying diseases.…”

“…Multidrug-resistant bacteria are common in lung transplant recipients [10,25]. In our patients, multidrug-resistant P. aeruginosa was the most frequent microorganism in the patients with VAP, and was also common in those with VAT.…”

“…In the present study we found a marked association between VAP and mortality. In contrast, a recent investigation of the clinical response to antimicrobial therapy in ICU patients with pneumonia (ventilator-associated in 77.1% of the cases) after lung or heart-lung transplantation found no impact of the condition on ICU mortality [10]. However, a recent meta-analysis reported attributable mortality associated with VAP >60% in surgical patients [20] and larger previous studies in lung transplant recipients found that post-operative pneumonia significantly increased mortality [3,9].…”

“…In the past few years, protocols for immunosuppression and antibiotic prophylaxis have been developed [6] and antimicrobial resistance has increased [7], and all this may have changed the impact of respiratory infections on the outcomes of lung transplant recipients. There are also inconsistencies in the definitions of pneumonia and tracheobronchitis, which may partly explain the conflicting results between studies of the impact of post-lung-transplant respiratory infection [3,[8][9][10].…”

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“…Nosocomial pneumonia is observed in 47% lung transplant recipients during their ICU stay, and 40% of patients who had nosocomial pneumonia had pneumonia recurrence. 29 Most frequently isolated organisms were Enterobacteriaceae, Pseudomonas aeruginosa, and Staphylococcus aureus. Another retrospective study reported that in lung transplant recipients, new pulmonary infiltrates occurring after the first month are most likely due to infection, with bacterial pathogens responsible in 50% pneumonias.…”