Management and prophylaxis of bacterial and mycobacterial infections among lung transplant recipients

Abstract

Bacterial and mycobacterial infections are associated with morbidity and mortality in lung transplant recipients. Infectious complications are categorized by timing post-transplant: <1, 1-6, and >6 months. The first month post-transplant is associated with the highest risk of infection. During this period, infections are most commonly healthcare-associated, and include infections related to surgical complications. The lungs and bloodstream are common sites of infections. Common healthcare-associated organisms include methicillin-resistant Staphylococcus aureus (MRSA), Gram-negative bacilli such as Pseudomonas aeruginosa, and Clostridioides difficile. More than 1-month post-transplant, opportunistic infections can occur. Tuberculosis occurs in 0.8-10% of lung transplant recipients which reflects variation in background prevalence. The majority of post-transplant tuberculosis stems from reactivation of untreated or undiagnosed latent tuberculosis. Most post-transplant tuberculosis occurs in the lungs and develops within a year of transplant. Non-tuberculous mycobacteria commonly colonize the lungs of lung transplantcandidates and are often hard to eradicate even with prolonged courses of antimycobacterial agents. Drug interactions between antimycobacterial agents and calcineurin and mTOR inhibitors also complicates treatment post-transplant. Given that infection adversely impacts outcomes after lung transplant, and that anti-infective therapy is often less effective after transplant, infection prevention is key to long-term success. A comprehensive approach that includes pre-transplant evaluation, perioperative prophylaxis, longterm antimicrobial prophylaxis, immunization, and safer living at home and in the community, should be employed to minimize the risk of infection.

Lung and Cerebral Nocardiosis Caused by <i>Nocardia elegans</i> in a Lung Transplant Recipient: A Case Report and Literature Review

“…Several mechanisms underlying the increased susceptibility of patients with lung transplantation to Nocardia have been proposed ( 3 , 4 , 9 ). First, the transplanted lung is exposed to the external environment via the airway and is prone to inhalation of airborne microorganisms.…”

One-Step Soft Agar Enrichment and Isolation of Human Lung Bacteria Inhibiting the Germination of Aspergillus fumigatus conidia

“…P. aeruginosa is an opportunistic pathogen and is commonly isolated in lung transplanted patients [30,31]. Antibacterials, as well as antifungals, are often used as prophylactic or therapeutic treatments in lung transplanted patients [32,33]. Das, Bernasconi [20] showed that there is a negative relationship between the number of antibiotics administered to transplanted patients and the imbalance of the lung microbiota, with Pseudomonas spp.…”

The Impact of Resistant Bacterial Pathogens including Pseudomonas aeruginosa and Burkholderia on Lung Transplant Outcomes

“…Early optimization of recipients with up-todate immunizations and effective, targeted perioperative and postoperative antibiotic prophylaxis is critical, to minimize the impacts of surgical site infection, pneumonia, and ongoing bacterial infection. 87 There has been interest in the use of long-term azithromycin therapy post-LTx, in an attempt to alter microbial presence in the allograft and reduce the burden of Pseudomonas and/or BCC colonization. Spence et al conducted a retrospective analysis of 69 LTx recipients and monitored changes in BAL microbiota composition and cytokine expression.…”