Targeted Antibiotic Prophylaxis for Lung Transplantation in Cystic Fibrosis Patients Colonised withPseudomonas aeruginosaUsing Multiple Combination Bactericidal Testing

Abstract

Early infection is a recognised complication after lung transplantation in patients with cystic fibrosis (CF). Our centre uses multiple combination bactericidal testing (MCBT) when determining appropriate peritransplant prophylactic regimens. To evaluate our strategy, we compared the incidence of posttransplant infection in patients whose peritransplant antimicrobial regimens were determined using MCBT versus standard sensitivity testing. Patients with CF who were infected with Pseudomonas aeruginosa and underwent lung transplantations between 2000 and 2010 were included. Data was collected from clinical records and our microbiology database. Microorganisms cultured were mapped against antibiotic resistance, method of sensitivity testing, and antibiotics administered peritransplant. 129 patients were identified (mean age 28, male : female, 63 : 66). Fifty patients (38.8%) had antibiotics determined by MCBT. Two patients in the MCBT group developed septicaemia, 13 in the conventional group (P ≤ 0.05, 2-tailed Fisher's test). Sepsis was attributable to P. aeruginosa in one patient from the MCBT group and seven patients in the conventional group (P = 0.15). P. aeruginosa was recovered from the posttransplant pleural fluid of one patient who received MCBT-guided prophylaxis, six patients in the conventional group (P = 0.25). Patients given antibiotics based on MCBT had significantly lower rates of septicaemia and lower rates of empyema.

Worldwide clinical practices in perioperative antibiotic therapy for lung transplantation

“…However, alternative decolonization strategies are emerging in the perioperative period of a LTx. Indeed, different solutions have been tested with interesting results, such as perioperative tracheobronchial lavage and/or pleural irrigation with antiseptic solutions [34,35] or a combination of antibiotic therapies [36,37].…”

Organ Transplantation for Cystic Fibrosis

“…21 To reduce the risk of perioperative sepsis at the time of lung transplantation, patients with CF require a combination of perioperative antibiotics targeting their pretransplant microbiology, but the duration of such therapy varies from center to center. Some centers previously utilized antimicrobial synergy testing to target pan-resistant Pseudomonas and reduce the risk of perioperative infections and sepsis, but the overall effect on short-and long-term survival is questionable, 22,23 so synergy testing is no longer used. Other centers employ the continued use of nebulized antipseudomonal antibiotics in patients with CF to reduce the colonizing load of bacteria in the upper airway that may lead to infections.…”

Lung Transplantation for Cystic Fibrosis: Results, Indications, Complications, and Controversies

“…91,102,103 The same strain/clone of PA may persist in CF patients pre-and post-LT. 101,103 Importantly, PA isolates in CF are often MDR. [104][105][106][107] However, panresistant PA in CF LTRs has been associated with a modest reduction in survival in some, 108 but not all, 109,110 studies. In one two-center study, 103 CF patients post-LT were evaluated (53 from University of Toronto; 50 from Duke University).…”