Service de Biologie Clinique, Hôpital Foch, Suresnes, France.
Service de Biologie Clinique, Hôpital Foch, Suresnes, France; Université Paris-Saclay, INSERM Hémostase Inflammation Thrombose HITH U1176, Le Kremlin-Bicêtre, France.
J Heart Lung Transplant. 2024 Jan;43(1):169-180. doi: 10.1016/j.healun.2023.09.023. Epub 2023 Oct 3.
Urogenital Mollicutes, that is, Mycoplasma hominis and Ureaplasma spp., can colonize the urogenital tract. While urogenital colonization is frequent, infections are rare but should not be missed. Furthermore, extragenital infections are even rarer. Over the past years, they have been increasingly documented as a cause of hyperammonemia syndrome (HS) and post-surgical infections. We review the literature on studies focused on post-surgical infections and HS involving urogenital Mollicutes after thoracic surgery including lung (LTR) and heart (HTR) transplantation.
A systematic review was performed by searching PubMed/Medline case reports, case series, cohort studies, and clinical trials. Cases of infections and HS by urogenital Mollicutes after HTR and LTR transplantations were reported.
Overall, urogenital Mollicutes were associated with 15 HS, 31 infections in HTR and LTR, and 18 post-thoracic surgical infections in another context. Post-surgical infections were reported in all contexts. They were mainly due to M hominis, the only species that could cultivate on standard enriched agar forming pinpoint colonies after 3-5 days of incubation. Microbiologists should be prompted to pinpoint colonies even if the examination of Gram-staining is negative. The patients' management required surgical treatment and antimicrobials, almost always tetracyclines and/or fluoroquinolones. Conversely, HS occurred almost exclusively in bilateral LTR and is more likely due to Ureaplasma spp. As Ureaplasma spp. do not cultivate on standard media, the microbiological diagnosis was performed using molecular methods.
Infections involving urogenital Mollicute should be considered in LTR with HS. The overall rate of mortality is high and might be due in part to delay in etiologic diagnosis. Post-surgical infections were reported in all contexts. The route of contamination with Mollicutes remains unknown in HTR and non-transplant surgery, but evidence of transmission from donors has been documented for LTR.
泌尿生殖道柔膜体纲，即人型支原体和脲原体属，可定植于泌尿生殖道。虽然泌尿生殖道定植很常见，但感染却很少见，但不应忽视。此外，外阴感染更为罕见。近年来，它们越来越多地被记录为高氨血症综合征（HS）和手术后感染的原因。我们综述了关于胸外科手术后泌尿生殖道柔膜体纲引起的 HS 和感染的文献，包括肺（LTR）和心脏（HTR）移植。
通过搜索 PubMed/Medline 的病例报告、病例系列、队列研究和临床试验，进行了系统综述。报告了 HTR 和 LTR 移植后泌尿生殖道柔膜体纲引起的感染和 HS 病例。
总体而言，泌尿生殖道柔膜体纲与 15 例 HS、31 例 HTR 和 LTR 感染以及 18 例其他背景下的胸外科后感染有关。所有情况下均报告了手术后感染。它们主要由 M hominis 引起，该物种只能在标准增菌琼脂上培养，培养 3-5 天后形成针尖状菌落。即使革兰氏染色检查为阴性，微生物学家也应提示针尖状菌落。患者的治疗需要手术治疗和抗生素，几乎总是四环素类和/或氟喹诺酮类。相反，HS 几乎仅发生在双侧 LTR，更可能由脲原体属引起。由于脲原体属不能在标准培养基上培养，因此使用分子方法进行微生物诊断。
LTR 合并 HS 时应考虑泌尿生殖道柔膜体纲感染。总的死亡率很高，部分原因可能是病因诊断延迟。所有情况下均报告了手术后感染。HTR 和非移植手术中柔膜体纲的污染途径尚不清楚，但已有证据表明 LTR 从供体传播。
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