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 language | English (US) |
|---|---|
| Pages (from-to) | 371-374 |
| Number of pages | 4 |
| Journal | Transplantation Proceedings |
| Volume | 41 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2009 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Surgery
- Transplantation
Cite this
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 journal › Article
}
TY - JOUR
T1 - Pneumonia in Solid Organ Recipients
T2 - Spectrum of Pathogens in 217 Episodes
AU - Bonatti, H.
AU - Pruett, T. L.
AU - Brandacher, Gerald
AU - Hagspiel, K. D.
AU - Housseini, A. M.
AU - Sifri, C. D.
AU - Sawyer, R. G.
PY - 2009/1
Y1 - 2009/1
N2 - 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.
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.
UR - http://www.scopus.com/inward/record.url?scp=60649084227&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=60649084227&partnerID=8YFLogxK
U2 - 10.1016/j.transproceed.2008.10.045
DO - 10.1016/j.transproceed.2008.10.045
M3 - Article
C2 - 19249559
AN - SCOPUS:60649084227
VL - 41
SP - 371
EP - 374
JO - Transplantation Proceedings
JF - Transplantation Proceedings
SN - 0041-1345
IS - 1
ER -