Ventilator-associated respiratory infection following lung transplantation

Abstract

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

What’s new in ventilator-associated pneumonia?

“…A particular challenge is the development of pneumonia in the postoperative period of lung transplantation because its presentation may overlap with acute rejection that requires the opposite therapeutic approach (increase versus decrease of immunosuppressors). Recently, Riera and colleagues [2] reported that pneumonia was related to increased in-hospital death (42.9 vs 11.5 %; p = 0.01), while tracheobronchitis was not related to increased mortality (14.0 vs 14.7 %; p = 0.9) but both prolonged the duration of MV by more than 1 week. Interestingly, tracheobronchitis doubled episodes of pneumonia in this subset of patients.…”

Epidemiology and risk factors of multidrug‐resistant bacteria in respiratory samples after lung transplantation

“…Compared to other solid organ transplantations, lung transplantation (LT) is characterized by a higher complication rate and a lower survival rate . Respiratory tract infections are among the most prevalent early post‐LT complications, accounting for significant morbidity and mortality .…”

Antibiotic-Resistant Infections and Treatment Challenges in the Immunocompromised Host

“…8 With the exception of the studies from Al-Hasan and colleagues, 6 Azap and colleagues, 13 and Riera and colleagues, 9 the incidence of ESBL production in enteric pathogens was at least 40%. [6][7][8][9]11,12,14,21,23,25 Two other studies reported the proportion of enteric bacilli that were MDR (14.5% and 54.8%, respectively), but did not specify if these were ESBL producing or not. 26,28 One other study looked at the number of patients who were colonized with ESBL producing pathogens before liver transplantation.…”

“…Data for methicillin-resistant Staphylococcus aureus (MRSA) were limited, with only 4 studies reviewed reporting on MRSA. [7][8][9][10] The prevalence of MRSA had wide variability being as low as 18% 9 and as high as 80%. 10 Few of these studies looked at Enterococcus spp.…”