供体呼吸多重耐药菌与肺移植结局。

Donor respiratory multidrug-resistant bacteria and lung transplantation outcomes.

机构信息

Lung Health Centre Department, Organ Transplant Centre of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia.

Lung Health Centre Department, Organ Transplant Centre of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

出版信息

J Infect. 2024 Feb;88(2):139-148. doi: 10.1016/j.jinf.2023.12.013. Epub 2024 Jan 17.

DOI:10.1016/j.jinf.2023.12.013

PMID:38237809

Abstract

RATIONALE

Respiratory culture screening is mandatory for all potential lung transplant donors. There is limited evidence on the significance of donor multidrug-resistant (MDR) bacteria on transplant outcomes. Establishing the safety of allografts colonized with MDR bacteria has implications for widening an already limited donor pool.

OBJECTIVES

We aimed to describe the prevalence of respiratory MDR bacteria among our donor population and to test for associations with posttransplant outcomes.

METHODS

This retrospective observational study included all adult patients who underwent lung-only transplantation for the first time at King Faisal Specialist Hospital & Research Centre in Riyadh from January 2015 through May 2022. The study evaluated donor bronchoalveolar lavage and bronchial swab cultures.

MAIN RESULTS

Sixty-seven of 181 donors (37%) had respiratory MDR bacteria, most commonly MDR Acinetobacter baumannii (n = 24), methicillin-resistant Staphylococcus aureus (n = 18), MDR Klebsiella pneumoniae (n = 8), MDR Pseudomonas aeruginosa (n = 7), and Stenotrophomonas maltophilia (n = 6). Donor respiratory MDR bacteria were not significantly associated with allograft survival or chronic lung allograft dysfunction (CLAD) in adjusted hazard models. Sensitivity analyses revealed an increased risk for 90-day mortality among recipients of allografts with MDR Klebsiella pneumoniae (n = 6 with strains resistant to a carbapenem and n = 2 resistant to a third-generation cephalosporin only) compared to those receiving culture-negative allografts (25.0% versus 11.1%, p = 0.04). MDR Klebsiella pneumoniae (aHR 3.31, 95%CI 0.95-11.56) and Stenotrophomonas maltophilia (aHR 5.35, 95%CI 1.26-22.77) were associated with an increased risk for CLAD compared to negative cultures.

CONCLUSION

Our data suggest the potential safety of using lung allografts with MDR bacteria in the setting of appropriate prophylaxis; however, caution should be exercised in the case of MDR Klebsiella pneumoniae.

摘要

背景

呼吸培养筛查是所有潜在肺移植供体的强制性要求。关于供体多重耐药（MDR）细菌对移植结果的意义，证据有限。确定被 MDR 细菌定植的同种异体移植物的安全性，这对扩大已经有限的供体池具有重要意义。

目的

我们旨在描述我们的供体人群中呼吸 MDR 细菌的流行情况，并检验其与移植后结局的相关性。

方法

这项回顾性观察性研究纳入了 2015 年 1 月至 2022 年 5 月期间在利雅得的法赫德国王专科医院和研究中心首次接受肺移植的所有成年患者。该研究评估了供体支气管肺泡灌洗和支气管刷检培养物。

主要结果

181 名供体中有 67 名（37%）存在呼吸 MDR 细菌，最常见的是 MDR 鲍曼不动杆菌（n=24）、耐甲氧西林金黄色葡萄球菌（n=18）、MDR 肺炎克雷伯菌（n=8）、MDR 铜绿假单胞菌（n=7）和嗜麦芽寡养单胞菌（n=6）。在调整后的风险模型中，供体呼吸 MDR 细菌与移植物存活率或慢性肺移植物功能障碍（CLAD）无显著相关性。敏感性分析显示，与接受培养阴性移植物的患者相比，接受携带 MDR 肺炎克雷伯菌（携带对碳青霉烯类耐药的菌株的患者 n=6 和仅对第三代头孢菌素耐药的菌株 n=2）的患者，90 天死亡率的风险增加（25.0%与 11.1%，p=0.04）。与阴性培养相比，MDR 肺炎克雷伯菌（aHR 3.31，95%CI 0.95-11.56）和嗜麦芽寡养单胞菌（aHR 5.35，95%CI 1.26-22.77）与 CLAD 风险增加相关。