囊性纤维化患者的流行性铜绿假单胞菌感染并非肺移植后临床预后不良的危险因素。

Epidemic Pseudomonas aeruginosa infection in patients with cystic fibrosis is not a risk factor for poor clinical Outcomes following lung transplantation.

作者信息

Pritchard Julia, Thakrar Mitesh V, Somayaji Ranjani, Surette Michael G, Rabin Harvey R, Helmersen Doug, Lien Dale, Purighalla Swathi, Waddell Barbara, Parkins Michael D

机构信息

Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.

Department of Biochemistry, and the Farncombe Family Digestive Health Research Institute, McMaster University, 1280 Main Street West, Hamilton ON L8S 4L8, Canada; Department of Microbiology, Immunology & Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.

出版信息

J Cyst Fibros. 2016 May;15(3):392-9. doi: 10.1016/j.jcf.2015.11.004. Epub 2015 Dec 3.

DOI:10.1016/j.jcf.2015.11.004

PMID:26657575

Abstract

BACKGROUND

Epidemic strains of Pseudomonas aeruginosa (ePA) causing infection in cystic fibrosis (CF) have been commonly identified from clinics around the world. ePA disproportionally impacts CF patient pre-transplant outcomes manifesting in increased exacerbation frequency, worsened treatment burden and increased rate of lung function decline, and disproportionally leads to death and/or transplantation. As other CF factors such as pre-transplant infection with multi-resistant organisms, and isolation of P. aeruginosa in the post transplant graft, may impact post-transplant outcomes, we sought to determine if infection with ePA similarly adversely impact post-transplant outcomes.

METHODS

Between 1991-2014, 53 CF patients from our center received lung transplants. Bacterial strain typing was performed retrospectively on isolates collected prior to transplantation. Comprehensive chart reviews were performed to obtain baseline patient characteristics and post-transplant outcomes.

RESULTS

Of the 53 transplanted patients, 57% of patients were infected with ePA prior to transplant; the other 43% of patients had unique strains of P. aeruginosa. Mean age at transplant was 29.0years for ePA and 33.3years for unique (p=0.04). There were no differences in overall survival (HR=0.75, 95% CI 0.31-1.79), bronchiolitis obliterans syndrome (BOS) free survival (HR 1.43, 95% CI 0.54-4.84) or all other assessed outcomes including exacerbation frequency, chronic renal failure, acute cellular rejections, Aspergillus infection, airway stenosis, and post-transplant lymphoproliferative disorder.

CONCLUSION

Unlike pre-transplant outcomes, CF patients infected with ePA do not experience worse post-transplant outcomes than those infected with unique strains. Therefore, lung transplantation should be considered for all patients with P. aeruginosa infection and end stage lung disease, irrespective of infection with ePA.

摘要

背景

在世界各地的诊所中，已普遍鉴定出导致囊性纤维化（CF）患者感染的铜绿假单胞菌流行菌株（ePA）。ePA对CF患者移植前的预后产生了不成比例的影响，表现为病情加重频率增加、治疗负担加重以及肺功能下降速度加快，并且不成比例地导致死亡和/或移植。由于其他CF因素，如移植前多重耐药菌感染以及移植后移植物中分离出铜绿假单胞菌，可能会影响移植后的预后，我们试图确定感染ePA是否同样会对移植后的预后产生不利影响。

方法

1991年至2014年间，我们中心的53名CF患者接受了肺移植。对移植前收集的分离株进行回顾性细菌菌株分型。进行全面的病历审查以获取患者的基线特征和移植后的预后。

结果

在53名移植患者中，57%的患者在移植前感染了ePA；其他43%的患者感染的是独特的铜绿假单胞菌菌株类型。ePA感染患者移植时平均年龄为29.0岁，独特菌株感染患者为33.3岁（p=0.04）。在总生存率（风险比[HR]=0.75，95%置信区间[CI]0.31-1.79）、无闭塞性细支气管炎综合征（BOS）生存率（HR 1.43，95%CI 0.54-4.84）或所有其他评估的预后方面，包括病情加重频率、慢性肾功能衰竭、急性细胞排斥反应、曲霉菌感染、气道狭窄和移植后淋巴细胞增生性疾病，均无差异。