Infections after lung transplantation: time of occurrence, sites, and microbiologic etiologies
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Background/Aims: Infections are major causes of both early and late death after lung transplantation (LT). The development of prophylaxis strategies has altered the epidemiology of post-LT infections; however, recent epidemiological data are limited. We evaluated infections after LT at our institution by time of occurrence, site of infections, and microbiologic etiologies. Methods: All consecutive patients undergoing lung or heart-lung transplantation between October 2008 and August 2014 at our institution were enrolled. Cases of infections after LT were initially identified from the prospective registry database, which was followed by a detailed review of the patients’ medical records. Results: A total of 108 episodes of post-LT infections (56 bacterial, 43 viral, and nine fungal infections) were observed in 34 LT recipients. Within 1 month after LT, the most common bacterial infections were catheter-related bloodstream infections (42%). Pneumonia was the most common site of bacterial infection in the 2- to 6-month period (28%) and after 6 months (47%). Cytomegalovirus was the most common viral infection within 1 month (75%) and in the 2- to 6-month period (80%). Respiratory viruses were the most common viruses after 6 months (48%). Catheter-related candidemia was the most common fungal infection. Invasive pulmonary aspergillosis developed after 6 months. Survival rates at the first and third years were 79% and 73%, respectively. Conclusions: Although this study was performed in a single center, we provide valuable and recent detailed epidemiology data for post-LT infections. A further multicenter study is required to properly evaluate the epidemiology of post-LT infections in Korea.
Abstract
Background/Aims: Infections are major causes of both early and late death after lung transplantation (LT). The development of prophylaxis strategies has altered the epidemiology of post-LT infections; however, recent epidemiological data are limited. We evaluated infections after LT at our institution by time of occurrence, site of infections, and microbiologic etiologies. Methods: All consecutive patients undergoing lung or heart-lung transplantation between October 2008 and August 2014 at our institution were enrolled. Cases of infections after LT were initially identified from the prospective registry database, which was followed by a detailed review of the patients’ medical records. Results: A total of 108 episodes of post-LT infections (56 bacterial, 43 viral, and nine fungal infections) were observed in 34 LT recipients. Within 1 month after LT, the most common bacterial infections were catheter-related bloodstream infections (42%). Pneumonia was the most common site of bacterial infection in the 2- to 6-month period (28%) and after 6 months (47%). Cytomegalovirus was the most common viral infection within 1 month (75%) and in the 2- to 6-month period (80%). Respiratory viruses were the most common viruses after 6 months (48%). Catheter-related candidemia was the most common fungal infection. Invasive pulmonary aspergillosis developed after 6 months. Survival rates at the first and third years were 79% and 73%, respectively. Conclusions: Although this study was performed in a single center, we provide valuable and recent detailed epidemiology data for post-LT infections. A further multicenter study is required to properly evaluate the epidemiology of post-LT infections in Korea.
참고문헌 (19)
- Yusen RD, "The registry of the International Society for Heart and Lung Transplantation: thirty-first adult lung and heart-lung transplant report: 2014; focus theme: retransplantation", J Heart Lung Transplant, 33, pp.1009~1024 (2014)
- "National data for organ transplantation" (2014)[URL]
- de Perrot M, "Twenty-year experience of lung transplantation at a single center:influence of recipient diagnosis on long-term survival", J Thorac Cardiovasc Surg, 127, pp.1493~1501 (2004)
- Zander DS, "Analysis of early deaths after isolated lung transplantation", Chest, 120, pp.225~232 (2001)
- Kanj SS, "Infections in patients with cystic fibrosis following lung transplantation", Chest, 112, pp.924~930 (1997)
- Maurer JR, "Infectious complications following isolated lung transplantation", Chest, 101, pp.1056~1059 (1992)
- Parada MT, "Early and late infections in lung transplantation patients", Transplant Proc, 42, pp.333~335 (2010)
- Humar A, "AST ID Working Group on Infectious Disease Monitoring. American Society of Transplantation recommendations for screening, monitoring and reporting of infectious complications in immunosuppression trials in recipients of organ transplantation", Am J Transplant, 6, pp.262~274 (2006)
- Raad I, "Differential time to positivity: a useful method for diagnosing catheter-related bloodstream infections", Ann Intern Med, 140, pp.18~25 (2004)
- Stewart S, "Revision of the 1996 working formulation for the standardization of nomenclature in the diagnosis of lung rejection", J Heart Lung Transplant, 26, pp.1229~1242 (2007)
- Sang Young Kim, "Late Respiratory Infection after Lung Transplantation", Tuberculosis and Respiratory Diseases, 74(2), pp.63~69 (2013), 대한결핵및호흡기학회
- Murray S, "Impact of burkholderia infection on lung transplantation in cystic fibrosis", Am J Respir Crit Care Med, 178, pp.363~371 (2008)
- Avery RK., "Infections after lung transplantation", Semin Respir Crit Care Med, 27, pp.544~551 (2006)
- Palmer SM, "Extended valganciclovir prophylaxis to prevent cytomegalovirus after lung transplantation: a randomized, controlled trial", Ann Intern Med, 152, pp.761~769 (2010)
- Razonable RR, "AST Infectious Diseases Community of Practice. Cytomegalovirus in solid organ transplantation", Am J Transplant, 13(Suppl 4), pp.93~106 (2013)
- Chang YS, "Two cases of post transplant lymphoproliferative disorder in lung transplant recipients", Korean J Intern Med, 19, pp.276~281 (2004)
- 백효채, "폐 이식 수술의 10년 치험", The Korean Journal of Thoracic and Cardiovascular Surgery, 39(11), pp.822~827 (2006), 대한흉부외과학회
- Allen UD, "AST Infectious Diseases Community of Practice. Epstein-Barr virus and posttransplant lymphoproliferative disorder in solid organ transplantation", Am J Transplant, 13(Suppl 4), pp.107~120 (2013)
- Minari A, "The incidence of invasive aspergillosis among solid organ transplant recipients and implications for prophylaxis in lung transplants", Transpl Infect Dis, 4, pp.195~200 (2002)