Kalra Vikram, Agarwal Sanjay Kumar, Khilnani Gopi Chand, Kapil Arti, Dar Lalit, Singh Urvashi B, Mirdha Bijay Ranjan, Xess Immaculata, Gupta Sanjay, Bhowmik Dipankar, Tiwari Suresh Chand, Dash Suresh Chand
Department of Nephrology, All India Institute of Medical Sciences, New Delhi, 110029, India. .
Int Urol Nephrol. 2005;37(3):551-9. doi: 10.1007/s11255-005-4012-9.
Pulmonary infections have been implicated as the most common cause of infection related mortality in renal transplant recipients. An appropriate empirical treatment of post transplant pulmonary infections requires knowledge of the spectrum of the microorganisms involved in causing these infections. Besides this knowledge, an aggressive diagnostic approach including the use of invasive tests is often essential to make an early diagnosis for instituting timely and appropriate therapy. We carried out a prospective cohort study to analyze the spectrum of pulmonary infections in these patients and study the utility of bronchoalveolar lavage (BAL) in the diagnosis of the same.
From September 2001 to December 2002, 428 patients were under follow up with the department. In all, 40 renal transplant recipients reported with 44 episodes of pulmonary infection during this study period. All patients underwent detailed and appropriate investigations including specific laboratory tests, sputum analysis, X-ray chest, CT and BAL. The spectrum of the causative organisms and the utility of BAL as compared to the other methods of diagnosis were studied and compared.
Out of the 44 episodes of pulmonary infection evaluated, single causative organism could be found in only 24 (54.5%) episodes and multiple etiologies were found in 15 (34.1%) episodes. No definitive cause could be found in 5 episodes. Out of 57 organisms isolated in the 44 episodes, 20 (45.4 %) were bacteria, 16 (36.3 %) each were M. tuberculosis and fungus, 3 were CMV infection and 2 were nocardia. BAL gave a diagnostic yield of 75.8% (25 out of 33 cases). Nine of forty patients died (mortality rate 22.5%) of which 6 deaths could be attributed directly to pulmonary infection. Out of these 9 patients who died, cause of pulmonary infection was bacterial in 5, fungal in 2 and CMV disease in 1. In one patient, organism could not be isolated.
Our study has shown that more than 1/3rd of pulmonary infections in renal transplant recipients can be attributed to multiple organisms. Bacterial infections were the commonest cause of post transplant pulmonary infection. Tuberculosis is common cause of pulmonary infection in these patients in our set up. Because of its high diagnostic yield, BAL should be considered in all patients with suspected pulmonary infections in the post transplant period.
肺部感染被认为是肾移植受者感染相关死亡的最常见原因。对移植后肺部感染进行恰当的经验性治疗需要了解引发这些感染的微生物谱。除了这方面的知识外，积极的诊断方法，包括使用侵入性检查，对于早期诊断以便及时进行恰当治疗通常至关重要。我们开展了一项前瞻性队列研究，以分析这些患者的肺部感染谱，并研究支气管肺泡灌洗（BAL）在诊断中的效用。
2001年9月至2002年12月，该科室对428例患者进行随访。在此研究期间，共有40例肾移植受者报告了44次肺部感染发作。所有患者均接受了详细且恰当的检查，包括特定实验室检查、痰液分析、胸部X线、CT和BAL。研究并比较了致病微生物谱以及BAL与其他诊断方法相比的效用。
在评估的44次肺部感染发作中，仅在24次发作（54.5%）中发现单一致病微生物，15次发作（34.1%）中发现多种病因。5次发作中未发现明确病因。在44次发作中分离出的57种微生物中，20种（45.4%）为细菌，结核分枝杆菌和真菌各16种（36.3%），3种为巨细胞病毒感染，2种为诺卡菌。BAL的诊断阳性率为75.8%（33例中的25例）。40例患者中有9例死亡（死亡率22.5%），其中6例死亡可直接归因于肺部感染。在这9例死亡患者中，肺部感染原因细菌感染5例，真菌感染2例，巨细胞病毒疾病1例。1例患者未分离出微生物。
我们的研究表明，肾移植受者超过三分之一的肺部感染可归因于多种微生物。细菌感染是移植后肺部感染最常见的原因。在我们的研究中，结核病是这些患者肺部感染的常见原因。由于其诊断阳性率高，对于所有移植后疑似肺部感染的患者均应考虑进行BAL检查。
