Microbiological findings in bronchoalveolar lavage fluid from lung transplant patients in Sweden

Aspelund, Anna Stjärne; Hammarström, Helena; Inghammar, Malin; Larsson, Hillevi; Hansson, Lennart; Riise, Gerdt C.; Friman, Vanda; Christensson, Bértil; Påhlman, Lisa I.

doi:10.1111/tid.12973

Cited by 13 publications

(8 citation statements)

References 27 publications

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“…For diagnosing pathogen which was responsible for pulmonary infection, mNGS assays showed that the most prevalent pathogens mainly consisted of bacteria, particularly in LTRs at the early post-lung transplantation stages, which was in line with the results of several studies ( 27 – 29 ). The three most prevalent bacteria were Pseudomonas aeruginosa , Enterococcus and Klebsiella pneumoniae .…”

Section: Discussionsupporting

confidence: 87%

Metagenomic Next-Generation Sequencing for Diagnosing Infections in Lung Transplant Recipients: A Retrospective Study

et al. 2022

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Background: Accurate identification of pathogens is essential for the diagnosis and control of infections. We aimed to compare the diagnostic performance of metagenomic next-generation sequencing (mNGS) and conventional detection methods (CDM) in lung transplant recipients (LTRs).Methods: We retrospectively analyzed 107 LTRs with suspected infection of pulmonary, blood, central nervous system or chest wall between March 2018 and November 2020. Bronchoalveolar lavage fluid and other body fluids were subject to pathogen detection by both mNGS and CDM.Results: Of the 163 specimens, 84 (51.5%) tested positive for both mNGS and culture, 19 (11.7%) of which were completely consistent, 44 (27.0%) were partially congruent, and 21 (12.9%) were discordant (kappa = .215; p = .001). Compared with CDM, mNGS detected a higher diversity of pathogens. Moreover, the turn-around time was significantly shorter for mNGS compared with culture (2.7 ± .4 vs. 5.5 ± 1.6 days, p < .001). As an auxiliary method, treatment strategies were adjusted according to mNGS findings in 31 cases (29.0%), including eight patients with non-infectious diseases, who were finally cured.Conclusion: mNGS can identify pathogens with a shorter turn-around time and therefore provide a more accurate and timely diagnostic information to ascertaining pulmonary infections. mNGS might have a role in differentiating infectious from non-infectious lung diseases in LTRs.

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Section: Discussionsupporting

confidence: 87%

Metagenomic Next-Generation Sequencing for Diagnosing Infections in Lung Transplant Recipients: A Retrospective Study

et al. 2022

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“…For example, cultures are limited to known and culturable species, and they are unable to differentiate between microbes causing disease versus microbes colonizing asymptomatic carriers [ 6 ]. This was illustrated in an earlier study, where we demonstrated that bacterial findings in BALF cultures were similar in patients with and without clinical signs of infection at the time of sampling [ 7 ]. The difficulty in interpreting culture findings emphasizes the great need for new tools, including microbiome analyses, to identify and understand the aetiology of respiratory infections in these patients [ 6 ].…”

Section: Introductionsupporting

confidence: 54%

Divergent airway microbiomes in lung transplant recipients with or without pulmonary infection

2021

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Background Lung transplant (LTx) recipients are at increased risk for airway infections, but the cause of infection is often difficult to establish with traditional culture-based techniques. The objectives of the study was to compare the airway microbiome in LTx patients with and without ongoing airway infection and identify differences in their microbiome composition. Methods LTx recipients were prospectively followed with bronchoalveolar lavage (BAL) during the first year after transplantation. The likelihood of airway infection at the time of sampling was graded based on clinical criteria and BAL cultures, and BAL fluid levels of the inflammatory markers heparin-binding protein (HBP), IL-1β and IL-8 were determined with ELISA. The bacterial microbiome of the samples were analysed with 16S rDNA sequencing and characterized based on richness and evenness. The distance in microbiome composition between samples were determined using Bray–Curtis and weighted and unweighted UniFrac. Results A total of 46 samples from 22 patients were included in the study. Samples collected during infection and samples with high levels of inflammation were characterized by loss of bacterial diversity and a significantly different species composition. Burkholderia, Corynebacterium and Staphylococcus were enriched during infection and inflammation, whereas anaerobes and normal oropharyngeal flora were less abundant. The most common findings in BAL cultures, including Pseudomonas aeruginosa, were not enriched during infection. Conclusion This study gives important insights into the dynamics of the airway microbiome of LTx recipients, and suggests that lung infections are associated with a disruption in the homeostasis of the microbiome.

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“…The cough reflex is essential in the clearance of foreign material, infectious agents, and mucus from the airways. The consequences of poor airway clearance can include pulmonary infection, chronic inflammation, and long-term damage to the lung airways or parenchyma ( Leith et al, 2011 ; Stjärne Aspelund et al, 2018 ). The cough reflex in both human subjects and animals can be initiated through mechanical and chemical stimulation of the upper airways and the tracheobronchial tree ( Canning et al, 2006 ; Karlsson and Fuller, 1999 ; Laude et al, 1993 ; Mazzone and Undem, 2016 ; Tatar et al, 1994 ; Widdicombe, 1996 ).…”

Section: Introductionmentioning

confidence: 99%

Influence of intrathoracic vagotomy on the cough reflex in the anesthetized cat

Shen

Pertzborn

Rose

et al. 2022

Respiratory Physiology & Neurobiology

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Recurrent laryngeal afferent fibers are primarily responsible for cough in response to mechanical or chemical stimulation of the upper trachea and larynx in the guinea pig. Lower airway slowly adapting receptors have been proposed to have a permissive effect on the cough reflex. We hypothesized that vagotomy below the recurrent laryngeal nerve branch would depress mechanically or chemically induced cough. In anesthetized, bilaterally thoracotomized, artificially ventilated cats, thoracic vagotomy nearly eliminated cough induced by mechanical stimulation of the intrathoracic airway, significantly depressed mechanically stimulated laryngeal cough, and eliminated capsaicin-induced cough. These results support an important role of lower airway sensory feedback in the production of tracheobronchial and laryngeal cough in the cat. Further, at least some of this feedback is due to excitation from pulmonary volume-sensitive sensory receptors.

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Microbiological findings in bronchoalveolar lavage fluid from lung transplant patients in Sweden

Abstract: This study gives important epidemiologic insights and reinforces that microbiological findings have to be evaluated in the light of clinical symptoms and endobronchial appearance in the assessment of lung infections in lung transplant patients.

Cited by 13 publications

References 27 publications

Metagenomic Next-Generation Sequencing for Diagnosing Infections in Lung Transplant Recipients: A Retrospective Study

Metagenomic Next-Generation Sequencing for Diagnosing Infections in Lung Transplant Recipients: A Retrospective Study

Divergent airway microbiomes in lung transplant recipients with or without pulmonary infection

Influence of intrathoracic vagotomy on the cough reflex in the anesthetized cat

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