Forier Bart, Schaevers Veronique, Spriet Isabel, Quintens Charlotte, Desmet Stefanie, Bos Saskia, Bleyenbergh Pascal Van, Lorent Natalie, Sadeleer Laurens De, Godinas Laurent, Dupont Lieven J, Vos Robin
Leuven Transplant Center and Department of Respiratory Diseases, University Hospitals Leuven, Herestraat 49, Leuven, B-3000, Belgium.
Lung Transplant Team, Clinical Nurse Specialist, University Hospitals Leuven, Leuven, Belgium.
Eur J Clin Microbiol Infect Dis. 2024 Aug 28. doi: 10.1007/s10096-024-04921-9.
Bacterial isolation is associated with worse outcomes after lung transplantation (LTx), and successful bacterial eradication is shown to improve long-term survival and pulmonary function. Outpatient Parenteral Antibiotic Therapy (OPAT) may be an effective therapeutic modality for bacterial eradication post-LTx.
A single-center, retrospective analysis of OPAT characteristics, efficacy, safety, and costs in non-cystic fibrosis LTx recipients.
A total of 156 OPAT courses (from June 2019 to December 2022) were evaluated in 108 distinct LTx recipients. OPAT mainly consisted of dual antibiotic therapy (69%) for pulmonary bacterial isolation (97%), mostly Pseudomonas aeruginosa (66%). Successful eradication at 3 months post-OPAT was achieved in 71%. Eradication rate was significantly higher in patients treated after the first post-operative year (79%), compared to patients within the first year (61%) (p = 0.017). Eradication rate was similar for multidrug resistance (eradication rate 61%) versus no multidrug resistance (74%) (p = 0.116). Spirometry remained stable at 90 days post-OPAT. A statistically significant, but clinically negligible, increase in serum creatinine at 90 days post-OPAT was observed (1.33 mg/dL vs. 1.39 mg/dL, p < 0.001), yet unrelated to the antibiotic regimen used. OPAT-related hospital admissions occurred in 13% and line-related adverse events in 6%. Median number of hospitalization days saved per OPAT-course was 10 days (range 2-92), accounting for a total of 1841 avoided admission days and an estimated net cost reduction of 47% per treatment course.
OPAT is an effective and safe therapeutic modality for bacterial eradication post-LTx, associated with a significant reduction in hospitalization days and treatment costs.
细菌感染与肺移植（LTx）后较差的预后相关，成功根除细菌可改善长期生存率和肺功能。门诊胃肠外抗生素治疗（OPAT）可能是LTx后根除细菌的一种有效治疗方式。
对非囊性纤维化LTx受者的OPAT特征、疗效、安全性和成本进行单中心回顾性分析。
在108名不同的LTx受者中评估了总共156个OPAT疗程（从2019年6月至2022年12月）。OPAT主要包括针对肺部细菌感染（97%）的双联抗生素治疗（69%），其中大部分为铜绿假单胞菌感染（66%）。OPAT后3个月成功根除细菌的比例为71%。与术后第一年以内的患者（61%）相比，术后第一年以后接受治疗的患者根除率显著更高（79%）（p = 0.017）。多重耐药患者的根除率（61%）与非多重耐药患者（74%）相似（p = 0.116）。OPAT后90天肺活量测定结果保持稳定。OPAT后90天观察到血清肌酐有统计学意义但临床可忽略不计的升高（1.33mg/dL对1.39mg/dL，p < 0.001），且与所用抗生素方案无关。OPAT相关的住院率为13%，与导管相关的不良事件发生率为6%。每个OPAT疗程节省的住院天数中位数为10天（范围2 - 92天），总共避免了1841个住院日，每个治疗疗程估计净成本降低47%。
OPAT是LTx后根除细菌的一种有效且安全的治疗方式，与住院天数和治疗成本的显著降低相关。
