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[Clin Infect Dis发表论文]:肺移植后早期的医院获得性及呼吸机相关性肺炎
2025年01月19日 时讯速递, 进展交流 [Clin Infect Dis发表论文]:肺移植后早期的医院获得性及呼吸机相关性肺炎已关闭评论

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

Laura N Walti,  Chun Fai Ng,  Qasim Mohiuddin,  et al

Clinical Infectious Diseases, Volume 79, Issue 4, 15 October 2024, Pages 1010–1017, https://doi.org/10.1093/cid/ciae399

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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