Nunley David R, Gal Anthony A, Vega J David, Perlino Carl, Smith Pauline, Lawrence E Clinton
Department of Internal Medicine, Andrew J. McKelvey Lung Transplantation Center, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA.
Chest. 2002 Oct;122(4):1185-91. doi: 10.1378/chest.122.4.1185.
To demonstrate an association between saprophytic fungal infections occurring at the bronchial anastomosis (BA) and the development of additional complications arising at this site.
Retrospective review.
University lung transplant center.
Review of all single-lung and double-lung transplant (LTX) recipients who underwent transplantation between June 1993 and December 2000. All recipients were subjected to surveillance bronchoscopy with biopsy at predetermined intervals and when clinically indicated. Bronchial wash fluid and biopsy material were examined using appropriate fungal stains and culture techniques. An infection was defined when fungal organisms were identified in tissue specimens.
Fifteen saprophytic fungal infections involving the BA were identified in 61 LTX recipients (24.6%) who survived a minimum of 75 days post-transplantation. Infections were attributed to Aspergillus sp (n = 9), Candida sp (n = 2), Torulopsis sp (n = 1), and mixed flora (ie, Penicillium + Candida, two patients; and Aspergillus + Candida, one patient). Saprophytic fungal infections occurred by a median of postoperative day 35 (range, 13 to 159 days). Airway complications involving the BA ultimately developed in 11 of 61 recipients (18%). These complications included symptomatic bronchial stenosis (nine patients), bronchomalacia (one patient), and fatal hemorrhage (one patient). Bronchial complications arose in 7 of 15 recipients (46.7%) with saprophytic fungal infections of the BA in contrast to 4 of 46 (8.7%) without infections (p = 0.003, Fisher exact test). Also demonstrated was a positive correlation between anastomotic infections and bronchial complications (Phi coefficient = 0.43; p = 0.001), while logistic regression analysis revealed that the absence of anastomotic infections predicted the absence of such complications (p = 0.002). The risk of developing an additional complication following an anastomotic infection in patients with infections was five times that of those recipients without an infection (relative risk, 5.36; 95% confidence interval [CI], 1.82 to 15.79). The odds in favor of a bronchial complication following an infection were eight times greater than in those recipients without infection (odds ratio, 8.31; 95% CI, 1.96 to 35.16).
Following LTX, saprophytic fungal infections of the BA are associated with serious airway complications.
证明支气管吻合口处腐生性真菌感染与该部位出现的其他并发症之间的关联。
回顾性研究。
大学肺移植中心。
回顾1993年6月至2000年12月期间接受移植的所有单肺和双肺移植受者。所有受者在预定间隔以及临床指征出现时接受监测性支气管镜检查及活检。使用适当的真菌染色和培养技术检查支气管冲洗液和活检材料。当在组织标本中鉴定出真菌生物体时定义为感染。
在61例移植后至少存活75天的肺移植受者（24.6%）中，发现15例涉及支气管吻合口的腐生性真菌感染。感染归因于曲霉菌属（n = 9）、念珠菌属（n = 2）、球拟酵母菌属（n = 1）以及混合菌群（即青霉菌 + 念珠菌，2例患者；曲霉菌 + 念珠菌，1例患者）。腐生性真菌感染发生的中位时间为术后第35天（范围为13至159天）。61例受者中有11例（18%）最终出现了涉及支气管吻合口的气道并发症。这些并发症包括有症状的支气管狭窄（9例患者）、支气管软化（1例患者）和致命性出血（1例患者）。在15例支气管吻合口有腐生性真菌感染的受者中，有7例（46.7%）出现支气管并发症，而在46例无感染的受者中有4例（8.7%）出现支气管并发症（Fisher精确检验，p = 0.003）。还证明了吻合口感染与支气管并发症之间存在正相关（Phi系数 = 0.43；p = 0.001），而逻辑回归分析显示无吻合口感染预示着无此类并发症（p = 0.002）。感染患者吻合口感染后出现额外并发症的风险是未感染受者的5倍（相对风险，5.36；95%置信区间[CI]，1.82至15.79）。感染后出现支气管并发症的几率比未感染受者高8倍（优势比，8.31；95%CI，1.96至35.16）。
肺移植后，支气管吻合口的腐生性真菌感染与严重的气道并发症相关。
