Bacteremia in Lung Transplant Recipients in the Current Era

Current trends in the epidemiology, outcome and variables influencing mortality in bacteremic lung transplant recipients have not been fully described. We prospectively studied bacteremias in lung transplant recipients in a multicenter study between 2000–2004. Bacteremia was documented in 56 lung transplant recipients, an average of 172 days after transplantation. Multiple antibiotic resistance was documented in 48% of the isolates; these included 57% of the Gram‐negative and 38% of the Gram‐positive bacteria. Pulmonary infection was the most common source of resistant gram‐negative bacteremias. Mortality rate at 28 days after the onset of bacteremia was 25% (14/56). Mechanical ventilation and abnormal mental status correlated independently with higher mortality (p < 0.05 for both variables). Bacteremia remains a significant complication in lung transplant recipients and is associated with considerable mortality. Recognition of variables portending a high risk for antibiotic resistance and for poor outcome has implications relevant for optimizing antibiotic prescription and for improving outcomes in lung transplant recipients.

[1]  D. Paterson,et al.  Bloodstream infections in organ transplant recipients receiving alemtuzumab: no evidence of occurrence of organisms typically associated with profound T cell depletion. , 2006, The Journal of infection.

[2]  E. Bouza,et al.  Bloodstream Infections among Heart Transplant Recipients , 2006, Transplantation.

[3]  J. Trotter,et al.  Immunosuppression: Evolution in Practice and Trends, 1994–2004 , 2006, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[4]  S. Palmer,et al.  Acute Renal Failure after Lung Transplantation: Incidence, Predictors and Impact on Perioperative Morbidity and Mortality , 2005, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[5]  Philip F Halloran,et al.  Immunosuppressive drugs for kidney transplantation. , 2004, The New England journal of medicine.

[6]  D. Snydman,et al.  The clinical impact of ganciclovir prophylaxis on the occurrence of bacteremia in orthotopic liver transplant recipients. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[7]  L. Danziger-Isakov Epidemiology of Bloodstream Infections in The First Year After Pediatric Lung Transplantation. , 2004, Pediatric Research.

[8]  R. Kotloff,et al.  Medical complications of lung transplantation , 2004, European Respiratory Journal.

[9]  J. Garnacho-Montero,et al.  Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis* , 2003, Critical care medicine.

[10]  D. Snydman,et al.  An international prospective study of pneumococcal bacteremia: correlation with in vitro resistance, antibiotics administered, and clinical outcome. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[11]  Nina Singh,et al.  Impact of current transplantation practices on the changing epidemiology of infections in transplant recipients. , 2003, The Lancet. Infectious diseases.

[12]  A. Mehta,et al.  Respiratory failure and sepsis are the major causes of ICU admissions and mortality in survivors of lung transplants. , 2003, Chest.

[13]  A. Matas,et al.  Predictors of renal function following lung or heart-lung transplantation. , 2002, Kidney international.

[14]  T. Fears,et al.  Incidence of septicaemias and invasive mycoses in children undergoing treatment for solid tumours: a 12-year experience at a single Italian institution. , 2001, European journal of cancer.

[15]  I. Marino,et al.  Evolving trends in multiple‐antibiotic–resistant bacteria in liver transplant recipients: A longitudinal study of antimicrobial susceptibility patterns , 2001, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[16]  B. Alexander,et al.  Significance of blood stream infection after lung transplantation: analysis in 176 consecutive patients. , 2000, Transplantation.

[17]  Nina Singh,et al.  Predicting bacteremia and bacteremic mortality in liver transplant recipients , 2000, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[18]  G Sherman,et al.  Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. , 1999, Chest.

[19]  C Brennen,et al.  Multiply Antibiotic Resistant Gram-Negative Bacilli in a Long Term Care Facility A Case Control Study of Patient rick Factors and Prior Antibiotic Use , 1997, Infection Control &#x0026; Hospital Epidemiology.

[20]  H. Oz,et al.  Novel anti-Pneumocystis carinii effects of the immunosuppressant mycophenolate mofetil in contrast to provocative effects of tacrolimus, sirolimus, and dexamethasone. , 1997, The Journal of infectious diseases.

[21]  E. De Clercq,et al.  Use of the yellow fever virus vaccine strain 17D for the study of strategies for the treatment of yellow fever virus infections. , 1996, Antiviral research.

[22]  J. Donnelly Bacterial complications of transplantation: diagnosis and treatment. , 1995, The Journal of antimicrobial chemotherapy.

[23]  N. Rolando,et al.  Bacterial and fungal infections after liver transplantation: An analysis of 284 patients , 1995, Hepatology.

[24]  N. Kneteman,et al.  Comparative Risk of Bloodstream Infection in Organ Transplant Recipients , 1994, Infection Control &#x0026; Hospital Epidemiology.

[25]  B. Griffith,et al.  A decade of lung transplantation. , 1993, Annals of surgery.

[26]  B. Yangco,et al.  CDC definitions for nosocomial infections. , 1989, American journal of infection control.

[27]  J M Hughes,et al.  CDC definitions for nosocomial infections, 1988. , 1988, American journal of infection control.