The impact of pan-resistant bacterial pathogens on survival after lung transplantation in cystic fibrosis: results from a single large referral centre

Dobbin, Catherine J.; Maley, Matthew P.; Harkness, John; Benn, Richard; Malouf, M.A.; Glanville, Allan R.; Bye, Peter

doi:10.1016/j.jhin.2004.01.003

Cited by 96 publications

(67 citation statements)

References 20 publications

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“…Two studies did not observe worse outcomes in this setting (18,153), but a third study did. Hadjiliadis and colleagues found that 43.7% of 103 CF patients undergoing lung transplantation were infected with panresistant bacteria other than Burkholderia (235).…”

Section: Pseudomonas Aeruginosamentioning

confidence: 87%

Clinical Significance of Microbial Infection and Adaptation in Cystic Fibrosis

et al. 2011

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SUMMARY A select group of microorganisms inhabit the airways of individuals with cystic fibrosis. Once established within the pulmonary environment in these patients, many of these microbes adapt by altering aspects of their structure and physiology. Some of these microbes and adaptations are associated with more rapid deterioration in lung function and overall clinical status, whereas others appear to have little effect. Here we review current evidence supporting or refuting a role for the different microbes and their adaptations in contributing to poor clinical outcomes in cystic fibrosis.

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Section: Pseudomonas Aeruginosamentioning

confidence: 87%

Clinical Significance of Microbial Infection and Adaptation in Cystic Fibrosis

et al. 2011

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“…There are only a few studies that examine the success rate of Pseudomonas eradication in post-transplant recipients [3,5,17,19]. In a larger study, including 87 patients with pre-transplant sinus surgery, 82 and 87% had persistent PNC and PPC, respectively [17].…”

Section: Discussionmentioning

confidence: 99%

Impact of Sinus Surgery on Pseudomonal Airway Colonization, Bronchiolitis Obliterans Syndrome and Survival in Cystic Fibrosis Lung Transplant Recipients

Vital¹,

Höfer

Benden

et al. 2012

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Background: Lung transplantation (LTx) is a therapy for patients with cystic fibrosis (CF) end-stage lung disease. Pseudomonal airway colonization (PAC) is common in CF. Objectives: We investigated the influence of post-transplant sinus surgery and daily nasal douching on PAC after LTx and the influence of PAC on survival and bronchiolitis obliterans syndrome (BOS). Methods: CF patients transplanted at our centre were included (November 1992 to December 2009). Clinical data, including microbiological data before and after LTx were collected. Survival and BOS following LTx were compared for CF recipients with and without PAC by Kaplan-Meier statistics and Cox regression analysis. Results: Ninety-four CF patients were transplanted, of whom 82 (87%) underwent sinus surgery after transplantation, and 65% of 66 patients with pre-transplant PAC had persistent PAC after transplantation. Upper and lower PAC is related. Patients without PAC after transplantation had a significantly better survival rate, and BOS was less frequent with a later onset. PAC was the only significant parameter for the development of BOS stage 2 in the multivariate analysis for cytomegalovirus infection, acute rejection and PAC. Conclusions: Sinus surgery and daily nasal douching reduced PAC in LTx recipients. Absence of post-transplant PAC had a positive impact on post-transplant survival and the development of BOS.

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“…Renal transplant patients are more likely to develop renal toxicity by different mechanisms (10), and renal dysfunction is adversely related to organ and recipient survival (11). On the other hand, due to the severity of the patients' conditions and the frequent use of antimicrobials, Gram-negative bacterial multiresistance is a major issue in hematopoietic stem cell transplantation and in solid organ transplantation (12)(13)(14), showing the ever-increasing need for polymyxin employment in this setting. Very few data regarding polymyxin toxicity, especially nephrotoxicity, are available for transplant patients.…”

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confidence: 99%

Nephrotoxicity and Efficacy Assessment of Polymyxin Use in 92 Transplant Patients

Mostardeiro

Pereira

Marra

et al. 2013

Antimicrob Agents Chemother

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bPolymyxins are old antimicrobials, discontinued for many years because of nephrotoxicity and neurotoxicity reports and reintroduced recently due to the increasing frequency of multiresistant Gram-negative bacterial infections. There are very few data related to toxicity and efficacy from transplanted patients, the major subjects of this study. All solid-organ-transplanted patients from our institution during January 2001 to December 2007 who used polymyxins were retrospectively assessed for nephrotoxicity and treatment efficacy. Microbiological and clinical cure rates were 100% and 77.2%, respectively. Only transplant patients subjected to at least 72 h of intravenous polymyxin were entered in the study. Overall, 92 transplant patients were included, and the nephrotoxicity rate was 32.6%. Multivariate analysis showed a statistically significant association between duration of polymyxin treatment (P ‫؍‬ 0.037; odds ratio [OR], 1.06; 95% confidence interval [CI], 1.00 to 1.12) and significant renal dysfunction. Polymyxin use is associated with very high rates of significant decrease in renal function; therefore, polymyxin must be used only when no other option is available and for as briefly as possible in the solid organ transplant setting.

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The impact of pan-resistant bacterial pathogens on survival after lung transplantation in cystic fibrosis: results from a single large referral centre

Cited by 96 publications

References 20 publications

Clinical Significance of Microbial Infection and Adaptation in Cystic Fibrosis

Clinical Significance of Microbial Infection and Adaptation in Cystic Fibrosis

Impact of Sinus Surgery on Pseudomonal Airway Colonization, Bronchiolitis Obliterans Syndrome and Survival in Cystic Fibrosis Lung Transplant Recipients

Nephrotoxicity and Efficacy Assessment of Polymyxin Use in 92 Transplant Patients

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