Cisneros J M, Muñoz P, Torre-Cisneros J, Gurgui M, Rodriguez-Hernandez M J, Aguado J M, Echaniz A
Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
Clin Infect Dis. 1998 Aug;27(2):324-31. doi: 10.1086/514649.
A multiinstitutional study of 307 heart transplant recipients was carried out to determine the clinical, radiographic, and prognostic characteristics, the incidence, and the etiology of pneumonias in the first year after transplantation. There were 21.1 cases of pneumonia per 100 heart transplantations. Seventy-five percent of the cases occurred in the first trimester. Eighty-two causal agents were identified, of which 60% were opportunistic, 25% were nosocomial, and 15% were community-acquired. The most frequent isolates were cytomegalovirus (20), Aspergillus species (13), and Pneumocystis carinii (11). Hemoptysis occurred more frequently in aspergillus pneumonias than in other pneumonias (54% vs. 6%, respectively; P < .05); aspergillus pneumonia was the only type of pneumonia during which cavitated nodules were noted on thoracic radiographs. The overall mortality rate was 30.8%; the independent factors of a poor prognosis were aspergillus infection (relative risk [RR], 7.4; 95% confidence interval [CI], 5.8-9.1) and bilateral pulmonary infiltrates (RR, 10; 95% CI, 8.5-11.4).
一项针对307名心脏移植受者的多机构研究开展，以确定移植后第一年肺炎的临床、影像学和预后特征、发病率及病因。每100例心脏移植中有21.1例肺炎。75%的病例发生在头三个月。共鉴定出82种病原体，其中60%为机会性感染，25%为医院获得性感染，15%为社区获得性感染。最常见的分离株为巨细胞病毒（20例）、曲霉菌属（13例）和卡氏肺孢子虫（11例）。咯血在曲霉菌性肺炎中比在其他肺炎中更常见（分别为54%和6%；P <.05）；曲霉菌性肺炎是胸部X线片上发现有空洞结节的唯一肺炎类型。总体死亡率为30.8%；预后不良的独立因素为曲霉菌感染（相对危险度[RR]，7.4；95%可信区间[CI]，5.8 - 9.1）和双侧肺部浸润（RR，10；95%CI，8.5 - 11.4）。
