CIBER de Enfermedades Respiratorias (CIBERES), Instituo Salud Carlos III, Madrid, Spain.
Clinical Research/Epidemiology In Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain.
Transpl Infect Dis. 2020 Oct;22(5):e13346. doi: 10.1111/tid.13346. Epub 2020 Jun 20.
The aim was to identify the causing organisms and assess the association of procalcitonin (PCT) with bacterial pneumonia within 24 hours of intensive care unit admission (ICU-A) among lung transplant (LT) adult recipients.
Secondary analysis from a prospective cohort study. All LT adults admitted to ICU for acute respiratory failure (ARF) over 5 years were included. Patients were followed until hospital discharge or death.
Fifty-eight consecutive LT patients were enrolled. The most important cause of ICU-A due to ARF was pneumonia 29 (50%) followed by acute rejection 3 (5.2%) and bronchiolitis obliterans syndrome exacerbation 3 (5.2%). Microorganisms were isolated from 22/29 cases with pneumonia (75.9%): 17 (77.2%) bacterial, 4 (18.2%) viral, 1 (4.5%) Aspergillus fumigates, with Pseudomonas aeruginosa being the most common cause (45.5%) of pneumonia, with 10 patients presenting chronic colonization by P aeruginosa. Median [Interquartile range (IQR)] PCT levels within 24 hours after admission were higher in pneumonia (1.5 µg/L; IQR:0.3-22.0), than in non-pneumonia cases (0.2 µg/L; IQR:0.1-0.7) (P = .019) and PCT levels within 24 hours helped to discriminate bacterial pneumonia (8.2 µg/L; IQR:0.2-43.0) from viral pneumonia and non-pneumonia cases (0.2 µg/L; IQR:0.1-0.7). The overall negative predictive value for bacterial pneumonia was 85.1%, increasing to 91.6% among episodes after 6 months of LT.
Causes of severe pneumonia in LT are changing, with predominant role of P aeruginosa and respiratory viruses. PCT ≤ 0.5 μg/L within 24 hours helps to exclude bacterial pneumonia diagnosis in LT adults requiring ICU-A. A negative PCT test allows antimicrobial de-escalation and requires an alternative diagnostic to bacterial pneumonia.
本研究旨在确定致病病原体，并评估在重症监护病房（ICU）入科（ICU-A）后 24 小时内降钙素原（PCT）与成人肺移植（LT）患者细菌性肺炎的相关性。
这是一项前瞻性队列研究的二次分析。研究纳入了 5 年内因急性呼吸衰竭（ARF）入住 ICU 的所有 LT 成人患者。患者的随访时间直至出院或死亡。
共纳入了 58 例连续的 LT 患者。导致 ICU-A 发生 ARF 的最重要原因是肺炎 29 例（50%），其次是急性排斥反应 3 例（5.2%）和闭塞性细支气管炎综合征恶化 3 例（5.2%）。29 例肺炎中有 22 例（75.9%）分离出微生物：17 例（77.2%）为细菌性，4 例（18.2%）为病毒性，1 例（4.5%）为烟曲霉，最常见的肺炎病原体为铜绿假单胞菌（45.5%），10 例患者存在铜绿假单胞菌慢性定植。入科后 24 小时内 PCT 中位数[四分位距（IQR）]在肺炎患者中更高（1.5 µg/L；IQR：0.3-22.0），而非肺炎患者中更低（0.2 µg/L；IQR：0.1-0.7）（P =.019），24 小时内 PCT 水平有助于鉴别细菌性肺炎（8.2 µg/L；IQR：0.2-43.0）、病毒性肺炎和非肺炎病例（0.2 µg/L；IQR：0.1-0.7）。细菌性肺炎的总体阴性预测值为 85.1%，LT 后 6 个月时增加至 91.6%。
LT 患者严重肺炎的病因正在发生变化，以铜绿假单胞菌和呼吸道病毒为主。LT 成人 ICU-A 患者入科后 24 小时内 PCT≤0.5 µg/L 有助于排除细菌性肺炎诊断。PCT 检测阴性可降低抗菌药物级别并需要进行替代诊断以排除细菌性肺炎。
