Osmani Morsal, Sotello David, Alvarez Salvador, Odell John A, Thomas Mathew
Clinical Research Internship Summer Program, Mayo Clinic, Jacksonville, FL, USA.
Department of Infectious Diseases, Mayo Clinic, Jacksonville, FL, USA.
Transpl Infect Dis. 2018 Apr;20(2):e12835. doi: 10.1111/tid.12835. Epub 2018 Feb 12.
To evaluate our institutional experience with Mycobacterium abscessus infections occurring in lung transplant recipients (LTR).
We retrospectively reviewed our prospectively collected institutional adult lung transplant database from 2001 to 2015 to identify patients with M. abscessus or Mycobacterium chelonae/abscessus infection before or after transplantation. Untreated, colonized patients were excluded from the study. Electronic health records of nine out of 516 lung recipients (1.74%) with clinical infection were reviewed to determine outcomes.
Seven patients acquired the infection after transplantation. Indications for transplantation were: idiopathic pulmonary fibrosis (in 6), chronic obstructive pulmonary disease (in 2), and cystic fibrosis (in 1). Five patients (55.5%) underwent bilateral lung transplantation; one patient required bilateral re-transplantation for complications from infection. M. abscessus was isolated from the respiratory tract with a median time of 7.5 months (range: 3 days to 13 months) from transplantation. All patients were treated using a multidrug regimen, with durations ranging from 3 days to 12 months. Complications from infection included death in one patient, bronchial anastomotic dehiscence in one patient, delayed bronchial occlusions in two patients, and osteomyelitis of the knee in one patient. Median survival time from transplantation was 39 months (range: 11-96 months) and from the date of first positive culture was 58 months (range: 3-91 months). Five patients (55.5%) were cured but two had re-infections >1 year later.
Mycobacterium abscessus infection in LTR is rare and can lead to severe complications. Eradication is difficult and usually requires prolonged combination antibiotic therapy and occasionally surgical management.
评估我们机构在肺移植受者（LTR）中发生脓肿分枝杆菌感染的经验。
我们回顾性分析了2001年至2015年前瞻性收集的机构成人肺移植数据库，以确定移植前后发生脓肿分枝杆菌或龟分枝杆菌/脓肿分枝杆菌感染的患者。未经治疗的定植患者被排除在研究之外。对516例肺移植受者中9例（1.74%）临床感染患者的电子健康记录进行回顾，以确定结局。
7例患者在移植后获得感染。移植指征为：特发性肺纤维化（6例）、慢性阻塞性肺疾病（2例）和囊性纤维化（1例）。5例患者（55.5%）接受了双肺移植；1例患者因感染并发症需要进行双侧再次移植。脓肿分枝杆菌从呼吸道分离出，从移植到分离的中位时间为7.5个月（范围：3天至13个月）。所有患者均采用多药方案治疗，疗程从3天至12个月不等。感染并发症包括1例患者死亡、1例患者支气管吻合口裂开、2例患者延迟性支气管闭塞和1例患者膝关节骨髓炎。移植后的中位生存时间为39个月（范围：11至96个月），从首次阳性培养日期起的中位生存时间为58个月（范围：3至91个月）。5例患者（55.5%）治愈，但2例在1年后再次感染。
LTR中的脓肿分枝杆菌感染罕见，可导致严重并发症。根除困难，通常需要长期联合抗生素治疗，偶尔需要手术处理。
