Holm Anna Engell, Schultz Hans Henrik Lawaetz, Johansen Helle Krogh, Pressler Tania, Lund Thomas Kromann, Iversen Martin, Perch Michael
Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
J Clin Med. 2021 Mar 19;10(6):1275. doi: 10.3390/jcm10061275.
Most cystic fibrosis (CF) patients referred for lung transplantation are chronically infected with Gram-negative opportunistic pathogens. It is well known that chronic infections in CF patients have a significant impact on lung-function decline and survival before transplantation. The rate and timing of re-colonization after transplantation have been described, but the impact on survival after stratification of bacteria is not well elucidated. We did a single-center retrospective analysis of 99 consecutive CF patients who underwent lung transplantation since the beginning of the Copenhagen Lung Transplant program in 1992 until October 2014. Two patients were excluded due to re-transplantation. From the time of CF diagnosis, patients had monthly sputum cultures. After transplantation, CF-patients had bronchoscopy with bronchoalveolar lavage at 2, 4, 6 and 12 weeks and 6, 12, 18 and 24 months after transplantation, as well as sputum samples if relevant. Selected culture results prior to and after transplantation were stored. We focused on colonization with the most frequent bacteria: (PA), (SM), (AX) and (BCC). Pulsed-field gel electrophoresis (PFGE) was used to identify clonality of bacterial isolates obtained before and after lung transplantation. Time to re-colonization was defined as the time from transplantation to the first positive culture with the same species. Seventy-three out of 97 (75%) had sufficient culture data for analyses with a median of 7 (1-91) cultures available before and after transplantation. Median colonization-free survival time was 23 days until the first positive culture after transplantation. After 2 years, 59 patients (81%) were re-colonized, 33 (48.5%) with PA, 7 (10.3%) with SM, 12 (17.6%) with AX, and 7 (10.3%) with BCC. No difference in survival was observed between the patients colonized within the first 2 years and those not colonized. Re-colonization of bacteria in the lower airways occurred at a median of 23 days after transplantation in our cohort. In our patient cohort, survival was not influenced by re-colonization or bacterial species.
大多数因肺移植而转诊的囊性纤维化(CF)患者长期感染革兰氏阴性机会性病原体。众所周知,CF患者的慢性感染对移植前的肺功能下降和生存有重大影响。移植后重新定植的发生率和时间已经有过描述,但细菌分层后对生存的影响尚未得到充分阐明。我们对自1992年哥本哈根肺移植项目启动至2014年10月期间连续接受肺移植的99例CF患者进行了单中心回顾性分析。两名因再次移植的患者被排除。从CF诊断之时起,患者每月进行痰培养。移植后,CF患者在移植后2、4、6和12周以及6、12、18和24个月进行支气管镜检查及支气管肺泡灌洗,如有需要还采集痰样本。储存移植前后选定的培养结果。我们重点关注最常见细菌的定植情况:铜绿假单胞菌(PA)、洋葱伯克霍尔德菌(SM)、嗜麦芽窄食单胞菌(AX)和支气管败血波氏杆菌(BCC)。脉冲场凝胶电泳(PFGE)用于鉴定肺移植前后获得的细菌分离株的克隆性。重新定植时间定义为从移植到首次出现相同菌种阳性培养的时间。97例患者中有73例(75%)有足够的培养数据用于分析,移植前后可获得的培养数据中位数为7次(1 - 91次)。移植后直至首次出现阳性培养的无定植生存时间中位数为23天。2年后,59例患者(81%)重新定植,33例(48.5%)为PA,7例(10.3%)为SM,12例(17.6%)为AX,7例(10.3%)为BCC。在移植后前2年内定植的患者与未定植的患者之间未观察到生存差异。在我们的队列中,下呼吸道细菌重新定植发生在移植后中位数23天。在我们的患者队列中,生存不受重新定植或细菌种类的影响。