Rabin Medical Center, Pulmonary Institute (affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv), Petah Tikva, Israel.
Department of Internal Medicine F, Shamir (Assaf Harofeh) Medical Center (affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv), Zerifin, Israel.
Interact Cardiovasc Thorac Surg. 2021 Jan 1;32(1):47-54. doi: 10.1093/icvts/ivaa221.
We evaluated associations of endobronchial stenting with airway bacterial colonization, the antimicrobial resistance profile, hospitalizations for pneumonia and survival in lung transplant recipients.
This is a retrospective single-centre study of 582 recipients of lung transplant during 2002-2018. We compared outcomes of 57 patients (9.7%) who received endobronchial stents (intervention group) to a control group of 57 patients without stents who were matched one to one for age, sex, year of transplantation, unilateral/bilateral transplantation and underlying disease.
For the intervention compared to the control group, airway colonization was more common for Pseudomonas (86% vs 35%, P < 0.001), Acinetobacter (21% vs 7%, P = 0.05), Klebsiella (21% vs 5%, P = 0.02) and Staphylococcus species (11% vs 0%, P = 0.02). The respective proportions of patients with positive bronchoalveolar lavage cultures on the third post-transplantation day, the day of stent insertion and 6-month post-stent insertion were 47.4%, 50.9% and 65.4% for Pseudomonas sp.; 15.8%, 12.3% and 3.8% for Klebsiella sp.; and 8.8%, 5.3% and 5.8% for Acinetobacter sp. The mean number of hospitalizations for pneumonia per patient was higher, without statistical significance, in the intervention than the control group (1.5 ± 1.7 vs 0.9 ± 1.5, P = 0.1). Kaplan-Meier survival curves did not show a statistically significant difference between the intervention group and the entire group without endobronchial stents (n = 525) (P = 0.4).
Lung transplant recipients with endobronchial stents were more likely to be colonized with pathologic bacteria and having pneumonia; however, stent placement was not associated with increased long-term mortality with appropriate stent maintenance.
我们评估了支气管内支架置入与气道细菌定植、抗菌药物耐药谱、肺炎住院和肺移植受者生存之间的关系。
这是一项回顾性单中心研究，纳入了 2002 年至 2018 年间接受肺移植的 582 例受者。我们比较了 57 例（9.7%）接受支气管内支架置入的患者（干预组）与 57 例未置入支架的患者（对照组）的结局，对照组患者通过年龄、性别、移植年份、单侧/双侧移植和基础疾病进行 1:1 匹配。
与对照组相比，干预组中气道定植更常见的病原体包括铜绿假单胞菌（86% vs 35%，P<0.001）、不动杆菌（21% vs 7%，P=0.05）、肺炎克雷伯菌（21% vs 5%，P=0.02）和葡萄球菌属（11% vs 0%，P=0.02）。在第 3 天、支架置入当天和支架置入后 6 个月时，支气管肺泡灌洗液培养阳性的患者比例分别为：铜绿假单胞菌为 47.4%、50.9%和 65.4%；肺炎克雷伯菌为 15.8%、12.3%和 3.8%；不动杆菌为 8.8%、5.3%和 5.8%。干预组肺炎住院率较对照组更高，但差异无统计学意义（1.5±1.7 比 0.9±1.5，P=0.1）。Kaplan-Meier 生存曲线显示，干预组与未置入支气管内支架的全组患者（n=525）之间无统计学显著差异（P=0.4）。
肺移植受者置入支气管内支架后更易发生病理性细菌定植和肺炎；但在适当的支架维护下，支架置入与长期死亡率增加无关。
