Post-operative Nosocomial Infections After Lung and Heart Transplantation

Mattner, Frauke; Fischer, Stefan; Weißbrodt, H.; Chaberny, Iris F.; Sohr, Dorit; Gottlieb, Jens; Welte, Tobias; Henke-Gendo, Cornelia; Gastmeier, Petra; Strueber, M.

doi:10.1016/j.healun.2006.12.009

Cited by 90 publications

(95 citation statements)

References 25 publications

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“…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]. The discrepancies between these studies may be attributed to differences in immunosuppression protocols, antibiotic regimens and microbiology patterns in the study centres.…”

Section: Discussionmentioning

confidence: 94%

“…Previous studies found that the rate of infectious complications is higher in lung transplant recipients than in recipients of other solid organs, and that infections accounted for >20% of mortality in the first 30 days following lung transplantation [9]. Bacterial pneumonia occurs most frequently in the early post-operative phase and, excluding primary graft dysfunction, is the major cause of new lung infiltrates in this period [17].…”

Section: Discussionmentioning

confidence: 98%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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Ventilator-associated respiratory infection following lung transplantation

et al. 2014

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The medical records of 170 adult patients who underwent lung transplantation between January 2010 and December 2012 were reviewed to assess the incidence, causative organisms, risk factors and outcomes of post-operative pneumonia and tracheobronchitis. 20 (12%) patients suffered 24 episodes of ventilator-associated pneumonia. The condition was associated with mean increases of 43 days in mechanical ventilation and of 35 days in hospital stay, and significantly higher hospital mortality (OR 9.0, 95% CI 3.2-25.1). Pseudomonas aeruginosa (eight out of 12 patients were multidrug-resistant) was the most common pathogen, followed by Enterobacteriaceae (one out of five patients produced extended-spectrum β-lactamases). Gastroparesis occurred in 55 (32%) patients and was significantly associated with pneumonia (OR 6.2, 95% CI 2.2-17.2). Ventilator-associated tracheobronchitis was associated with a mean increase of 28 days in mechanical ventilation and 30.5 days in hospital stay, but was not associated with higher mortality (OR 1.2, 95% CI 0.4-3.2). Pseudomonas aeruginosa (six out of 16 patients were multidrug resistant) was the most common pathogen, followed by Enterobacteriaceae (three out of 14 patients produced extended-spectrum β-lactamase). Patients with gastroparesis also had more episodes of ventilator-associated tracheobronchitis (40% versus 12%, p<0.001).In conclusion, ventilator-associated pneumonia following lung transplantation increased mortality. Preventing gastroparesis probably decreases the risk of pneumonia and tracheobronchitis. Multidrugresistant bacteria frequently cause post-lung-transplantation pneumonia and tracheobronchitis. @ERSpublications VAP following lung transplantation increases mortality and gastroparesis increases the incidence of VAP

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Ventilator-associated respiratory infection following lung transplantation

et al. 2014

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“…Despite improvements in the prevention of pneumonia, occurrence of pneumonia was independently predictive of mortality in this population. 9 In this study, the incidence of pulmonary infection was 15.8% in heart transplant recipients.…”

Section: Discussionmentioning

confidence: 59%

Long-Term Pulmonary Infections in Heart Transplant Recipients

Küpeli̇

Ulubay²,

Es³

et al. 2015

Exp Clin Transplant

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Objectives: Pulmonary infections are life-threatening complications in heart transplant recipients. Our aim was to evaluate long-term pulmonary infections and the effect of prophylactic antimicrobial strategies on time of occurrence of pulmonary infections in heart transplant recipients. Materials and Methods:Patients who underwent heart transplantation between 2003 and 2013 at Baskent University were reviewed. Demographic information and data about immunosuppression and infectious episodes were collected. Results: In 82 heart transplant recipients (mean age, 33.85 y; 58 male and 24 female), 13 recipients (15.8%) developed pulmonary infections (mean age, 44.3 y; 9 male and 4 female). There were 12 patients who had dilated cardiomyopathy and 1 patient who had myocarditis before heart transplantation; 12 patients received immunosuppressive therapy in single or combination form. Pulmonary infections developed in the first month (1 patient), from first to third month (6 patients), from third to sixth month (1 patient), and > 6 months after transplantation (5 patients). Chest computed tomography showed consolidation (unilateral, 9 patients; bilateral, 4 patients). Multiple nodular consolidations were observed in 2 patients and a cavitary lesion was detected in 1 patient. Bronchoscopy was performed in 6 patients; 3 patients had Aspergillus fumigatus growth in bronchoalveolar lavage fluid, and 2 patients had Acinetobacter baumannii growth in sputum. Treatment was empiric antibiotics (6 patients), antifungal drugs (5 patients), and both antibiotics and antifungal drugs (2 patients); treatment period was 1-12 months in patients with invasive pulmonary aspergillosis. Conclusions: Pulmonary infections are the most common cause of mortality in heart transplant recipients. A. fumigatus is the most common opportunistic pathogen. Heart transplant recipients with fever and cough should be evaluated for pulmonary infections, and invasive pulmonary aspergillosis should be suspected if these symptoms occur within the first 3 months. Immediately starting an empiric antibiotic is important in treating pulmonary infections in heart transplant recipients.

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“…The lungs are particularly vulnerable and represent a potential site of infection in patients undergoing cardiac transplantation [4,15]. This vulnerability is mainly due to immunosuppressive therapy, surgical procedure and the quality of life of patients and can be avoided through preventive measures for infection control [4,15].…”

Section: Introductionmentioning

confidence: 99%

Variáveis perioperatórias de função ventilatória e capacidade física em indivíduos submetidos a transplante cardíaco

Coronel

Bordignon²,

Bueno³

et al. 2010

Rev Bras Cir Cardiovasc

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Introduction: Heart transplantation is currently the only widely accepted surgical alternative to treat patients with severe heart failure (HF) drug therapy cannot maintain optimal quality of life appropriate.Objective: To describe and to compare the values between pre-and postoperative physical capacity and pulmonary patients who underwent heart transplantation.Methods: A retrospective cohort composed of patients undergoing heart transplantation between January 2001 to March 2005 in IC-FUC/RS.Results: Were included in the 21 individuals. We observed decreased levels of volume and lung capacity (FEV1 and FVC) in the first days after surgery compared to preoperatively (P <0.001) and recovery of these values in the 14th postoperative day (P <0.001). The values of muscle strength showed similar trends in reducing post-operative period compared to preoperative (P <0.001) and recovered on the 14 th postoperative day (P <0.001). A useful functional capacity, measured by testing 6-minute walk test (T6') showed improvement in the 14 th postoperative day in relation to pre-operatively (P <0.001). Conclusion:Changes in ventilatory function of subjects undergoing cardiac transplantation are predictable, but these recover respiratory muscle strength and lung capacity within two weeks, and improve functional capacity useful in relation to pre-operative, the transplantation, when indicated, associated with good functional rehabilitation is very god treatment strategy.Descriptors: Heart transplantation. Respiratory function tests. Forced expiratory flow rates. Exercise therapy. ResumoIntrodução: O transplante cardíaco é atualmente a única alternativa cirúrgica amplamente aceita para tratar pacientes com insuficiência cardíaca (IC) grave que a terapia medicamentosa otimizada não consiga manter qualidade de vida adequada.Objetivo: Descrever e comparar os valores entre pré e pós-operatório, das capacidades física e pulmonar de pacientes que realizaram transplante cardíaco. Bras Cir Cardiovasc 2010; 25(2): 190-196 bed, coughing and control techniques of pain [7,12], in addition to the practice of aerobic exercises. [17]. CORONEL, CC ET AL -Perioperative variables of ventilatory function and physical capacity in heart transplant patients RevDespite all the risks that patients with transplanted organ has to infection and rejection, this technique has shown great efficacy in survival, presenting results of survival rate of 90% in the first year and 87% in the fifth year posttransplant with good quality of life [18].This study aims to describe the values of physical and pulmonary abilities of patients who underwent heart transplant and who underwent conventional physiotherapy. Moreover, it aims to evaluate and compare the physical capacity of patients preoperatively and on day 14 th postoperative heart transplant and to evaluate and compare the forced vital capacity, forced expiratory volume in one second, maximum inspiratory muscle strength and the maximal expiratory muscle strength in pre-, 1st, 7th and 14 th postoperativ...

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Post-operative Nosocomial Infections After Lung and Heart Transplantation

Cited by 90 publications

References 25 publications

Ventilator-associated respiratory infection following lung transplantation

Ventilator-associated respiratory infection following lung transplantation

Long-Term Pulmonary Infections in Heart Transplant Recipients

Variáveis perioperatórias de função ventilatória e capacidade física em indivíduos submetidos a transplante cardíaco

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