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

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)371-374
Number of pages4
JournalTransplantation Proceedings
Volume41
Issue number1
DOIs
StatePublished - Jan 2009
Externally publishedYes

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Respiratory Tract Infections
Pneumonia
Organ Transplantation
Methicillin-Resistant Staphylococcus aureus
Mortality
Stenotrophomonas
Serratia
Enterobacter
Acinetobacter
APACHE
Klebsiella
Mechanical Ventilators
Cross Infection
Coinfection
Leukocyte Count
Liver Transplantation
Pseudomonas aeruginosa
Staphylococcus aureus
Pancreas
Fungi

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Bonatti, H., Pruett, T. L., Brandacher, G., Hagspiel, K. D., Housseini, A. M., Sifri, C. D., & Sawyer, R. G. (2009). Pneumonia in Solid Organ Recipients: Spectrum of Pathogens in 217 Episodes. Transplantation Proceedings, 41(1), 371-374. https://doi.org/10.1016/j.transproceed.2008.10.045

Pneumonia in Solid Organ Recipients : Spectrum of Pathogens in 217 Episodes. / Bonatti, H.; Pruett, T. L.; Brandacher, Gerald; Hagspiel, K. D.; Housseini, A. M.; Sifri, C. D.; Sawyer, R. G.

In: Transplantation Proceedings, Vol. 41, No. 1, 01.2009, p. 371-374.

Research output: Contribution to journalArticle

Bonatti, H, Pruett, TL, Brandacher, G, Hagspiel, KD, Housseini, AM, Sifri, CD & Sawyer, RG 2009, 'Pneumonia in Solid Organ Recipients: Spectrum of Pathogens in 217 Episodes', Transplantation Proceedings, vol. 41, no. 1, pp. 371-374. https://doi.org/10.1016/j.transproceed.2008.10.045
Bonatti, H. ; Pruett, T. L. ; Brandacher, Gerald ; Hagspiel, K. D. ; Housseini, A. M. ; Sifri, C. D. ; Sawyer, R. G. / Pneumonia in Solid Organ Recipients : Spectrum of Pathogens in 217 Episodes. In: Transplantation Proceedings. 2009 ; Vol. 41, No. 1. pp. 371-374.
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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.",
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AU - Housseini, A. M.

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AB - 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.

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