Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
J Clin Microbiol. 2018 Jul 26;56(8). doi: 10.1128/JCM.00142-18. Print 2018 Aug.
Although chronic respiratory disease and immunosuppression are risk factors for species respiratory infection, data are scarce regarding this disease in lung transplantation. Our aim was to describe the clinical characteristics and outcomes of lung transplant recipients (LTR) with respiratory isolation of spp. This was a retrospective observational study performed at a referral center in Barcelona, Spain (2014 to 2016). We included all LTR in whom spp. were isolated in at least one good-quality lower respiratory tract specimen. Overall, 24 of 527 (4.6%) LTR at risk during the study period were included. The main epidemiological, clinical, and microbiological data were analyzed. The most frequently isolated species were (11/24), (3/24), and (3/24). All 19 (76%) patients who underwent bronchoscopy showed abnormalities, mainly mucosal plaques at the bronchial suture and purulent secretions. Clinical cure was achieved in 8/12 (67%) patients who fulfilled the CDC definition of lower respiratory tract infection (LRTI). To assess the clinical relevance of spp., only patients with monomicrobial isolation ( = 18) were evaluated. LRTI was diagnosed in 9, and a nonsignificant association was found with a significant number of sp. CFU/ml (7/9 LRTI versus 2/9 non-LRTI, = 0.057). Persistent infection was associated with metallic bronchial stent implantation (4/4 versus 2/14, = 0.005). The isolation of spp. in respiratory specimens of lung transplant recipients may herald a respiratory tract infection or bronchial suture damage. Bronchial stent implantation is a risk factor for the persistence of species infection.
虽然慢性呼吸道疾病和免疫抑制是 种呼吸系统感染的危险因素,但关于肺移植患者 种感染的数据却很少。我们的目的是描述肺移植受者(LTR)中 种呼吸道分离株的临床特征和结局。这是在西班牙巴塞罗那的一个转诊中心进行的回顾性观察性研究(2014 年至 2016 年)。我们纳入了在至少一份下呼吸道标本中分离出 种的所有 LTR。在研究期间,有 24 例(4.6%)LTR 存在感染风险。分析了主要的流行病学、临床和微生物学数据。最常分离到的物种是 (11/24)、 (3/24)和 (3/24)。所有 19 例(76%)接受支气管镜检查的患者均显示异常,主要为支气管吻合处的黏膜斑块和脓性分泌物。符合美国疾病控制与预防中心(CDC)下呼吸道感染(LRTI)定义的 12 例患者中有 8 例(67%)临床治愈。为了评估 种的临床相关性,仅评估了单微生物分离的患者(=18)。9 例诊断为 LRTI,且 种 CFU/ml 数量与 LRTI 显著相关(7/9 LRTI 与 2/9 非 LRTI,=0.057)。持续性感染与金属支气管支架植入相关(4/4 与 2/14,=0.005)。LTR 的呼吸道标本中 种的分离可能预示着呼吸道感染或支气管吻合处损伤。支气管支架植入是 种持续感染的危险因素。