Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain.
Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
J Infect. 2020 Feb;80(2):190-196. doi: 10.1016/j.jinf.2019.12.006. Epub 2019 Dec 13.
Our aim was to analyze the prevalence of multidrug-resistant bacterial infections in lung transplant donors and to evaluate its influence on donor-derived bacterial infections.
We conducted a retrospective study of adult patients who underwent lung transplantation (2013-2016) at our hospital. Donor-derived bacterial infection was defined as the isolation of the same bacteria with identical antibiotic susceptibility patterns in the recipient and the perioperative cultures from the donor during the first month posttransplantation. We utilized a preventive antibiotic strategy adapted to the bacteria identified in donor cultures using systemic and nebulized antibiotics.
252 lung transplant recipients and 243 donors were included. In 138/243 (56.8%) donors, one bacterial species was isolated from at least one sample; graft colonization (118/243; 48.6%), blood cultures (5/243; 2.1%) and the contamination of preservation fluids (56/243; 23%). Multidrug-resistant bacteria were isolated from 12/243 (4.9%) donors; four Enterobacterales, four Stenotrophomonas maltophilia, three Pseudomonas aeruginosa and one methicillin-resistant Staphylococcus aureus. There was no transmission of these multidrug-resistant bacteria. Donor-derived infections, primarily tracheobronchitis due to non-MDR bacteria, were diagnosed in 7/253 (2.9%) recipients, with good clinical outcomes.
The lungs of donors colonized with multidrug-resistant bacteria may be safely used when recipients receive prompt tailored antibiotic treatment.
分析肺移植供体中多重耐药菌感染的流行情况，并评估其对供体来源细菌感染的影响。
我们对 2013 年至 2016 年在我院接受肺移植的成年患者进行了回顾性研究。供体来源的细菌感染定义为受体和供体在移植后第一个月的围手术期培养物中分离出相同的细菌，且具有相同的抗生素敏感性模式。我们采用了一种预防抗生素策略，根据供体培养物中鉴定的细菌，使用全身和雾化抗生素。
共纳入 252 例肺移植受者和 243 例供者。在 243 例供者中，有 138 例（56.8%）至少从一个样本中分离出一种细菌；移植物定植（118/243；48.6%）、血培养（5/243；2.1%）和保存液污染（56/243；23%）。从 12/243 例（4.9%）供者中分离出多重耐药菌；4 例肠杆菌科细菌、4 例嗜麦芽窄食单胞菌、3 例铜绿假单胞菌和 1 例耐甲氧西林金黄色葡萄球菌。这些多重耐药菌没有传播。在 253 例受者中，有 7 例（2.9%）诊断为供体来源的感染，主要为非多重耐药菌引起的气管支气管炎，临床结局良好。
当受者接受及时的靶向抗生素治疗时，可安全使用定植有多重耐药菌的供体肺。
