Details

Autor(en) / Beteiligte

• Bonatti, H
• Pruett, T.L
• Brandacher, G
• Hagspiel, K.D
• Housseini, A.M
• Sifri, C.D
• Sawyer, R.G

Titel

Pneumonia in Solid Organ Recipients: Spectrum of Pathogens in 217 Episodes

Ist Teil von

• Transplantation proceedings, 2009, Vol.41 (1), p.371-374

Ort / Verlag

Amsterdam: Elsevier Inc

Erscheinungsjahr

2009

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Background Lower respiratory tract infection (LRTI) remains a leading cause of morbidity and mortality after solid organ transplantation (SOT). Patients and methods We performed a retrospective analysis of 217 episodes of LRTI in 143 SOT patients from a single center. Results There were 94 men and 49 women (85% Caucasian) of median age of 51 (range 17–79) years, including 50 renal, 86 liver, 6 pancreas, and 1 lung recipient. Forty patients experienced multiple episodes of LRTI. Median APACHE II score was 17 (range 5–40), median temperature was 38°C (range 35.3°C–40.2°C), and median white blood cell count was 12000 (range 100–106,000). Pneumonia developed at a median of 11 (range 2–191) days after the last surgical intervention. Of the 217 LRTIs, 163 were nosocomial infections (60 ventilator-associated). Overall crude mortality of 21% was increased in patients with multiple episodes of LRTI (25%) and after liver transplantation (33%). In 40 cases, treatment was initiated without identification of a specific pathogen. Overall, 202 microorganisms were found (41 mixed infections): Staphylococcus aureus ( n = 32) of which 81% were MRSA; Escherichia coli ( n = 9); Klebsiella spp ( n = 7); Enterobacter spp ( n = 11); Serratia spp ( n = 12); Pseudomonas aeruginosa ( n = 15); Stenotrophomonas maltophila ( n = 15); Acinetobacter spp ( n = 9); fungi ( n = 18), and viruses ( n = 17). Conclusion LRTI remains one of the most common, dangerous infections in transplant recipients with higher mortality than in other populations. MRSA is a particular problem. As a significant number of SOT patients develop multiple episodes of LRTI, a thorough reevaluation of the current guidelines for the treatment of pneumonia is urgently needed.