Amore Davide, Pecoraro Ylenia, Carillo Carolina, Russo Gianluca, Poggi Camilla, Anile Marco, Pagini Andreina, Bassi Massimiliano, Cagnetti Sara, Mottola Emilia, D'Agostino Federica Gilda, Vannucci Jacopo, Mantovani Sara, Pugliese Francesco, De Giacomo Tiziano, Rendina Erino Angelo, Venuta Federico, Diso Daniele
Division of Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I, Rome, Italy.
Division of Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I, Rome, Italy.
Transplant Proc. 2020 Jun;52(5):1605-1607. doi: 10.1016/j.transproceed.2020.02.051. Epub 2020 Mar 21.
After lung transplantation (LTx), infections caused by multidrug-resistant (MDR) bacteria are frequent and difficult to treat. Some new antibiotics seem to be effective in treating these infections.
We describe our experience in treatment of Klebsiella pneumoniae MDR and Pseudomonas aeruginosa MDR infections with ceftazidime-avibactam (CEF-AVI) and ceftazidime-tazobactam (CEFT-TAZ) in patients who underwent LTx.
In 3 patients who underwent double LTx and in 4 patients who underwent single LTx, strains of K. pneumoniae and P. aeruginosa were isolated from bronchoalveolar lavage. All patients showed worsening of respiratory functions, increasing in inflammation indexes, and, in some cases, onset of pulmonary consolidation. P. aeruginosa was treated with CEFT-TAZ for 10 days average (7-15 days) and K. pneumoniae with CEF-AVI for 14 days average (4-24 days). One patient developed a septic state caused by K. pneumoniae, requiring 24 days of therapy. None had shown side effects caused by drugs administration. One patient died after 15 days from lung transplant owing to primary graft dysfunction.
CEF-AVI and CEFT-TAZ seems to be effective in treatment of infections caused by MDR bacteria after lung transplant.
肺移植（LTx）后，多重耐药（MDR）菌引起的感染很常见且难以治疗。一些新型抗生素似乎对治疗这些感染有效。
我们描述了在接受LTx的患者中，使用头孢他啶-阿维巴坦（CEF-AVI）和头孢他啶-他唑巴坦（CEFT-TAZ）治疗耐多药肺炎克雷伯菌和耐多药铜绿假单胞菌感染的经验。
在3例接受双侧LTx的患者和4例接受单侧LTx的患者中，从支气管肺泡灌洗中分离出肺炎克雷伯菌和铜绿假单胞菌菌株。所有患者均出现呼吸功能恶化、炎症指标升高，部分患者出现肺部实变。铜绿假单胞菌平均用CEFT-TAZ治疗10天（7 - 15天），肺炎克雷伯菌平均用CEF-AVI治疗14天（4 - 24天）。1例患者因肺炎克雷伯菌导致脓毒症状态，需要24天的治疗。均未出现药物给药引起的副作用。1例患者在肺移植后15天因原发性移植功能障碍死亡。
CEF-AVI和CEFT-TAZ似乎对治疗肺移植后由MDR菌引起的感染有效。
