Aguilar-Guisado M, Givaldá J, Ussetti P, Ramos A, Morales P, Blanes M, Bou G, de la Torre-Cisneros J, Román A, Borro J M, Lama R, Cisneros J M
Hospital Virgen del Rocío, Sevilla, Spain.
Am J Transplant. 2007 Aug;7(8):1989-96. doi: 10.1111/j.1600-6143.2007.01882.x.
The aim of the present study is to evaluate the epidemiology, etiology and prognosis of pneumonia in lung transplant (LT) recipients. This is a prospective, multicenter study of a consecutive cohort of LT recipients in Spain. From September 2003 to November 2005, 85 episodes of pneumonia in 236 LT recipients were included (incidence 72 episodes per 100 LT/year). Bacterial pneumonia (82.7%) was more frequent than fungal (14%) and viral pneumonia (10.4%). The most frequent microorganisms in each etiological group were Pseudomonas aeruginosa (n = 14, 24.6%), CMV (n = 6, 10.4%) and Aspergillus spp. (n = 5, 8.8%). Incidence of Aspergillus spp. and CMV pneumonia is lower than previously reported, probably due to the spread of universal prophylaxis. Pneumonia caused by viruses appeared significantly later than pneumonia due to gram-negative bacilli, fungi and those without known etiology (p < 0.01, p = 0.03 and p = 0.02, respectively). The routine use of ganciclovir has changed the natural history of CMV infection, so that pneumonia appears later, once prophylaxis is suspended. The probability of survival during the first year of follow-up was significantly higher in the multivariate analysis in LT recipients who did not have a pneumonia episode compared with those that had at least one episode (p < 0.01).
本研究的目的是评估肺移植（LT）受者肺炎的流行病学、病因及预后。这是一项针对西班牙LT受者连续队列的前瞻性多中心研究。2003年9月至2005年11月，纳入了236名LT受者中的85例肺炎发作（发病率为每100例LT每年72例发作）。细菌性肺炎（82.7%）比真菌性肺炎（14%）和病毒性肺炎（10.4%）更常见。各病因组中最常见的微生物分别是铜绿假单胞菌（n = 14，24.6%）、巨细胞病毒（CMV，n = 6，10.4%）和曲霉属（n = 5，8.8%）。曲霉属和CMV肺炎的发病率低于先前报道，可能是由于普遍预防措施的推广。病毒引起的肺炎出现时间明显晚于革兰氏阴性杆菌、真菌及病因不明的肺炎（分别为p < 0.01、p = 0.03和p = 0.02）。更昔洛韦的常规使用改变了CMV感染的自然病程，使得肺炎在预防措施暂停后出现得更晚。在多变量分析中，随访第一年无肺炎发作的LT受者的生存概率显著高于至少有一次肺炎发作的受者（p < 0.01）。
