Hadjiliadis D, Howell D N, Davis R D, Lawrence C M, Rea J B, Tapson V F, Perfect J R, Palmer S M
Departments of Medicine, Pathology, and Surgery, Duke University Medical Center, Durham, USA.
Ann Transplant. 2000;5(3):13-9.
Anastomotic infections are an uncommon but potentially devastating complication after lung transplantation. The incidence, microbiology, predisposing factors, and clinical outcomes of anastomotic infections have not been well described.
We performed a retrospective chart review of the first 283 lung or heart-lung transplant recipients performed at Duke University Medical Center and identified all cases of anastomotic infection.
Fifteen patients (5.3%) developed anastomotic infections. Aspergillus caused infection in six patients, Candida in eight patients and Staphylococcus aureus in one patient. Bilateral or right lung transplantation and the use of induction immunosuppression with monoclonoal or polyclonal antibodies are associated with a higher incidence of anastomotic infections. All patients with fungal anastomotic infections were treated with a combination of systemic and inhaled antifungal agents. All patients had improvement of their anastomotic sites after treatment and no patients developed anastomotic dehiscence.
Anastomotic infection is an infrequent complication after lung transplantation, and is caused predominately by fungal pathogens. In contrast to previous reports, anastomotic dehiscence did not occur in any patient in our series. Treatment with the combination of inhaled and systemic antimicrobial agents may have favorably affected clinical outcomes.
吻合口感染是肺移植术后一种少见但可能具有毁灭性的并发症。吻合口感染的发生率、微生物学特征、易感因素及临床结局尚未得到充分描述。
我们对杜克大学医学中心进行的首批283例肺或心肺移植受者进行了回顾性病历审查，并确定了所有吻合口感染病例。
15例患者（5.3%）发生了吻合口感染。6例患者感染由曲霉菌引起，8例由念珠菌引起，1例由金黄色葡萄球菌引起。双侧或右肺移植以及使用单克隆或多克隆抗体进行诱导免疫抑制与吻合口感染的较高发生率相关。所有真菌性吻合口感染患者均接受了全身和吸入性抗真菌药物联合治疗。所有患者治疗后吻合口部位均有改善，无一例患者发生吻合口裂开。
吻合口感染是肺移植术后罕见的并发症，主要由真菌病原体引起。与既往报道不同，我们系列研究中无一例患者发生吻合口裂开。吸入性和全身性抗菌药物联合治疗可能对临床结局产生了有利影响。
