Campos S, Caramori M, Teixeira R, Afonso J, Carraro R, Strabelli T, Samano M, Pêgo-Fernandes P, Jatene F
Lung Transplant Group, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Transplant Proc. 2008 Apr;40(3):822-4. doi: 10.1016/j.transproceed.2008.02.049.
The aim of this study was to evaluate the epidemiology of bacterial and fungal pneumonia in lung transplant (LT) recipients and to assess donor-to-host transmission of these microorganisms.
We retrospectively studied all positive cultures from bronchoalveolar lavage (BAL) of 49 lung transplant recipients and their donors from August 2003 to April 2007.
There were 108 episodes of pneumonia during a medium follow-up of 412 days (range, 1-1328 days). The most frequent microorganisms were: Pseudomonas aeruginosa (n = 36; 33.3%), Staphylococcus aureus (n = 29; 26.8%), and Aspergillus spp. (n = 18; 16%). Other fungal infections were due to Fusarium spp., Cryptococcus neoformans, and Paracoccidioides brasiliensis. Of the 31 donors with positive BAL, 15 had S. aureus. There were 21 pretransplant colonized recipients (43%) and 16 of them had suppurative underlying lung disease. P. aeruginosa was the most frequent colonizing organism (59% of pretransplant positive cultures). There were 11 episodes of bacteremia and lungs were the source in 5 cases. Sixteen deaths occurred and 6 (37.5%) were due to infection. Statistical analyses showed association between pretransplant colonizing microorganisms from suppurative lung disease patients and pneumonias after lung transplantation (RR = 4.76; P = .04; 95% CI = 1.02-22.10). No other analyzed factor was significant.
Bacterial and fungal infections are frequent and contribute to higher mortality in lung transplant recipients. P. aeruginosa is the most frequent agent of respiratory infections. This study did not observe any impact of donor lung organisms on pneumonia after lung transplantation. Nevertheless, we demonstrated an association between pretransplant colonizing microorganisms and early pneumonias in suppurative lung transplant recipients.
本研究旨在评估肺移植（LT）受者中细菌性和真菌性肺炎的流行病学情况，并评估这些微生物的供体-宿主传播。
我们回顾性研究了2003年8月至2007年4月期间49例肺移植受者及其供体支气管肺泡灌洗（BAL）的所有阳性培养结果。
在平均412天（范围1 - 1328天）的随访期间，共发生108例肺炎。最常见的微生物为：铜绿假单胞菌（n = 36；33.3%）、金黄色葡萄球菌（n = 29；26.8%）和曲霉属（n = 18；16%）。其他真菌感染由镰刀菌属、新型隐球菌和巴西副球孢子菌引起。在31例BAL阳性的供体中，15例有金黄色葡萄球菌。有21例移植前定植的受者（43%），其中16例有化脓性基础肺部疾病。铜绿假单胞菌是最常见的定植菌（移植前阳性培养的59%）。有11例菌血症，其中5例肺部是菌血症来源。16例患者死亡，6例（37.5%）死于感染。统计分析显示，化脓性肺部疾病患者移植前定植的微生物与肺移植后肺炎之间存在关联（RR = 4.76；P = .04；95% CI = 1.02 - 22.10）。其他分析因素均无统计学意义。
细菌和真菌感染在肺移植受者中很常见，且导致较高的死亡率。铜绿假单胞菌是最常见的呼吸道感染病原体。本研究未观察到供体肺部微生物对肺移植后肺炎有任何影响。然而，我们证明了移植前定植的微生物与化脓性肺移植受者早期肺炎之间存在关联。
