Hospital-Acquired and Ventilator-Associated Pneumonia Early After Lung Transplantation: A Prospective Study on Incidence, Pathogen Origin, and Outcome.

IF 8.2 1区 医学 Q1 IMMUNOLOGY Clinical Infectious Diseases Pub Date : 2024-10-15 DOI:10.1093/cid/ciae399
Laura N Walti, Chun Fai Ng, Qasim Mohiuddin, Roni Bitterman, Mohammed Alsaeed, William Klement, Tereza Martinu, Aman Sidhu, Tony Mazzulli, Laura Donahoe, Shaf Keshavjee, Lorenzo Del Sorbo, Shahid Husain
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Abstract

Background: Hospital-acquired (HAP) and ventilator-associated pneumonia (VAP) are important complications early (<30 days) after lung transplantation (LT). However, current incidence, associated factors, and outcomes are not well reported.

Methods: LT recipients transplanted at our institution (July 2019-January 2020 and October 2021-November 2022) were prospectively included. We assessed incidence and presentation of pneumonia and evaluated the impact of associated factors using regression models. We also evaluated molecular relatedness of respiratory pathogens collected peri-transplant and at pneumonia occurrence using pulsed-field gel electrophoresis (PFGE).

Results: In the first 30 days post-LT, 25/270 (9.3%) recipients were diagnosed with pneumonia (68% [17/25] VAP; 32% [8/25] HAP). Median time to pneumonia was 11 days (IQR, 7-13); 49% (132/270) of donor and 16% (44/270) of recipient respiratory peri-transplant cultures were positive. However, pathogens associated with pneumonia were not genetically related to either donor or recipient cultures at transplant, as determined by PFGE. Diagnosed pulmonary hypertension (HR, 4.42; 95% CI, 1.62-12.08) and immunosuppression use (HR, 2.87; 95% CI, 1.30-6.56) were pre-transplant factors associated with pneumonia. Pneumonia occurrence was associated with longer hospital stay (HR, 5.44; 95% CI, 2.22-13.37) and VAP with longer ICU stay (HR, 4.31; 95% CI, 1.73-10.75) within the first 30 days post-transplantation; 30- and 90-day mortality were similar.

Conclusions: Prospectively assessed early pneumonia incidence occurred in ∼10% of LT. Populations at increased risk for pneumonia occurrence include LT with pre-transplant pulmonary hypertension and pre-transplant immunosuppression. Pneumonia was associated with increased healthcare use, highlighting the need for further improvements by preferentially targeting higher-risk patients.

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肺移植术后早期的医院和呼吸机相关肺炎:关于发病率、病原体来源和结果的前瞻性研究。
背景:医院相关肺炎(HAP)和呼吸机相关肺炎(VAP)是早期重要的并发症:前瞻性地纳入了在我院接受移植的LT受者(2010年7月至2020年1月和2021年10月至2022年11月)。我们评估了肺炎的发病率和表现形式,并使用回归模型评估了相关因素的影响。此外,我们还使用脉冲-场效应凝胶电泳(PFGE)评估了移植前和肺炎发生时收集的呼吸道病原体的分子相关性:结果:在移植后的前 30 天,25/270(9.3%)名受者被诊断为肺炎(68% [17/25] VAP;32% [8/25] HAP)。肺炎的中位时间为 11 天(IQR 7-13)。49%(132/270)的供体和 16%(44/270)的受体呼吸道移植周围培养呈阳性。然而,根据 PFGE 测定,与肺炎相关的病原体与移植时供体或受体培养物的基因无关。在移植后的前30天内,肺炎的发生与较长的住院时间有关(HR 5.44,95% CI 2.22-13.37),VAP与较长的ICU住院时间有关(HR 4.31,95% CI:1.73-10.75);30天和90天的死亡率相似:通过前瞻性评估发现,约10%的LT患者会发生早期肺炎。肺炎发生风险增加的人群包括移植前肺动脉高压和移植前免疫抑制的LT患者。肺炎与医疗服务使用量的增加有关,因此需要通过优先选择高危患者来进一步改善医疗服务。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Infectious Diseases
Clinical Infectious Diseases 医学-传染病学
CiteScore
25.00
自引率
2.50%
发文量
900
审稿时长
3 months
期刊介绍: Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.
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