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Schaenman JM, Rossetti M, Korin Y, Sidwell T, Groysberg V, Liang E, Vangala S, Wisniewski N, Chang E, Bakir M, Bondar G, Cadeiras M, Kwon M, Reed EF, Deng M. T cell dysfunction and patient age are associated with poor outcomes after mechanical circulatory support device implantation. Hum Immunol 2018; 79:203-212. [PMID: 29409843 DOI: 10.1016/j.humimm.2018.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/27/2017] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Abstract
Immunologic impairment may contribute to poor outcomes after implantation of mechanical circulatory support device (MCSD), with infection often as a terminal event. The study of immune dysfunction is of special relevance given the growing numbers of older patients with heart disease. The aim of the study was to define which immunologic characteristics are associated with development of adverse clinical outcomes after MCSD implantation. We isolated peripheral blood mononuclear cells (PBMC) from patients pre- and up to 20 days post-MCSD implantation and analyzed them by multiparameter flow cytometry for T cell dysfunction, including terminal differentiation, exhaustion, and senescence. We used MELD-XI and SOFA scores measured at each time point as surrogate markers of clinical outcome. Older patients demonstrated increased frequencies of terminally differentiated T cells as well as NKT cells. Increased frequency of terminally differentiated and immune senescent T cells were associated with worse clinical outcome as measured by MELD-XI and SOFA scores, and with progression to infection and death. In conclusion, our data suggest that T cell dysfunction, independently from age, is associated with poor outcomes after MCSD implantation, providing a potential immunologic mechanism behind patient vulnerability to multiorgan dysfunction and death. This noninvasive approach to PBMC evaluation holds promise for candidate evaluation and patient monitoring.
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Affiliation(s)
- Joanna M Schaenman
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States.
| | - Maura Rossetti
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Yael Korin
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Tiffany Sidwell
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Victoria Groysberg
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Emily Liang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Sitaram Vangala
- UCLA Department of Medicine Statistics Core, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Nicholas Wisniewski
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Eleanor Chang
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Maral Bakir
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Galyna Bondar
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Martin Cadeiras
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Murray Kwon
- Department of Cardiothoracic Surgery, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Elaine F Reed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Mario Deng
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
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Stjärne Aspelund A, Hammarström H, Inghammar M, Larsson H, Hansson L, Christensson B, Påhlman LI. Heparin-binding protein, lysozyme, and inflammatory cytokines in bronchoalveolar lavage fluid as diagnostic tools for pulmonary infection in lung transplanted patients. Am J Transplant 2018; 18:444-452. [PMID: 28787761 PMCID: PMC5813223 DOI: 10.1111/ajt.14458] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/21/2017] [Accepted: 07/29/2017] [Indexed: 01/25/2023]
Abstract
Pulmonary infection is a common complication after lung transplantation, and early detection is crucial for outcome. However, the condition can be clinically difficult to diagnose and to distinguish from rejection. The aim of this prospective study was to evaluate heparin-binding protein (HBP), lysozyme, and the cytokines interleukin (IL)-1β, IL-6, IL-8, IL-10 and tumor necrosis factor (TNF) in bronchoalveolar lavage fluid (BALF) as potential biomarkers for pulmonary infection in lung-transplanted patients. One hundred thirteen BALF samples from 29 lung transplant recipients were collected at routine scheduled bronchoscopies at 3 and 6 months, or on clinical indication. Samples were classified into no, possible, probable, or definite infection at the time of sampling. Rejection was defined by biopsy results. HBP, lysozyme, and cytokines were analyzed in BALF and correlated to likelihood of infection and rejection. All biomarkers were significantly increased in BALF during infection, whereas patients with rejection presented low levels that were comparable to noninfection samples. HBP, IL-1β, and IL-8 were the best diagnostic markers of infection with area under the receiver-operating characteristic curve values of 0.88, 0.91, and 0.90, respectively. In conclusion, HBP, IL-1β, and IL-8 could be useful diagnostic markers of pulmonary infection in lung-transplanted patients.
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Affiliation(s)
- Anna Stjärne Aspelund
- Department of Infection ControlSkåne CountyLundSweden,Division of Infection MedicineDepartment of Clinical Sciences LundLund UniversitySkåne University HospitalLundSweden
| | - Helena Hammarström
- Department of Infectious DiseasesSahlgrenska Academy at University of GothenburgGöteborgSweden
| | - Malin Inghammar
- Division of Infection MedicineDepartment of Clinical Sciences LundLund UniversitySkåne University HospitalLundSweden
| | - Hillevi Larsson
- Division of Respiratory Medicine and AllergologyDepartment of Clinical SciencesLund UniversitySkåne University HospitalLundSweden
| | - Lennart Hansson
- Division of Respiratory Medicine and AllergologyDepartment of Clinical SciencesLund UniversitySkåne University HospitalLundSweden
| | - Bertil Christensson
- Division of Infection MedicineDepartment of Clinical Sciences LundLund UniversitySkåne University HospitalLundSweden
| | - Lisa I. Påhlman
- Division of Infection MedicineDepartment of Clinical Sciences LundLund UniversitySkåne University HospitalLundSweden
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103
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Solé A, García-Robles AA, Jordá C, Cases Viedma E, Mancheño N, Poveda-Andrés JL, Reig Mezquida JP, Pemán J. Salvage therapy with topical posaconazole in lung transplant recipients with invasive Scedosporium infection. Am J Transplant 2018; 18:504-509. [PMID: 29116676 DOI: 10.1111/ajt.14580] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/06/2017] [Accepted: 10/25/2017] [Indexed: 01/25/2023]
Abstract
Scedosporium is an important pathogen in cystic fibrosis (CF) and post-transplantation, but it rarely causes invasive infection. Treatment remains challenging, particularly due to the inherent resistance to multiple antifungal agents. We present 3 complicated invasive tracheobronchial and lung Scedosporium apiospermum infections following lung transplantation. In 2 of 3 cases, the infection was clinically and radiologically cured with frequent cleansing bronchoscopies, combining triazole with terbinafine therapy and nebulized posaconazole. These cases highlight the importance of adjunctive nebulized therapy in addition to prolonged triazole treatment to manage complex invasive Scedosporium infections in immunosuppressed patients. Posaconazole (PSZ) was delivered during the bronchoscopy procedure through intrabronchial administration, whereas an eFlow rapid® device was used for nebulized therapy. Topical posaconazole was well tolerated in 2 patients, with only a slight cough during administrations; the third patient had local irritation with poor tolerance, which led to its withdrawal. This is the first report on compassionate use of topical PSZ as salvage therapy for resistant mold infections in lung transplant recipients. These 3 cases represent the entire experience using this approach; no additional patients have received this therapy due to there not having been any additional cases of Scedosporium tracheobronchitis presented.
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Affiliation(s)
- Amparo Solé
- Lung Transplant and Cystic Fibrosis Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Carlos Jordá
- Lung Transplant and Cystic Fibrosis Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Enrique Cases Viedma
- Respiratory Endoscopy Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Nuria Mancheño
- Pathology Service, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Juan Pablo Reig Mezquida
- Lung Transplant and Cystic Fibrosis Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Javier Pemán
- Microbiology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
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104
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Dunn SP, Horslen S. Posttransplant Complications and Comorbidities. SOLID ORGAN TRANSPLANTATION IN INFANTS AND CHILDREN 2018. [PMCID: PMC7123596 DOI: 10.1007/978-3-319-07284-5_71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Stephen P. Dunn
- Department of Surgery, Jefferson Medical College, Wilmington, Delaware USA
| | - Simon Horslen
- Division of Gastroenterology, Seattle Children’s Hospital, Seattle, Washington USA
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105
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Kabbani D, Goldraich L, Ross H, Rotstein C, Husain S. Outbreak of invasive aspergillosis in heart transplant recipients: The role of screening computed tomography scans in asymptomatic patients and universal antifungal prophylaxis. Transpl Infect Dis 2017; 20. [PMID: 29125713 PMCID: PMC7169681 DOI: 10.1111/tid.12808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 07/12/2017] [Accepted: 07/30/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Delays in diagnosing pulmonary invasive aspergillosis (IA), a significant cause of morbidity and mortality among heart transplant recipients (HTRs), may impact on successful treatment. The appropriate screening strategy for IA in these patients remains undefined, particularly in the setting of nosocomial outbreaks. We describe our experience employing chest computed tomography (CT) scans as a screening method for IA. In addition, we comment on antimicrobial prophylaxis in HTRs in the setting of an outbreak. METHODS Screening CT scans of the chest and serum galactomannan (GM) were performed in HTRs during an outbreak that followed the index case of IA. Abnormal CT findings prompted a diagnostic workup. Antimicrobial prophylaxis for new transplants recipients included intravenous micafungin while hospitalized, followed by outpatient inhaled amphotericin B for up to 3 months. RESULTS During a 10-month period, five cases of IA were identified among HTRs. Two additional asymptomatic patients were diagnosed with IA among 15 asymptomatic HTRs who underwent screening chest CT scans. Among the five cases of IA in HTRs, two of five (40%) had a partial response and the other three failed voriconazole therapy. Complete response to voriconazole therapy assessed at 12 weeks was achieved in these two asymptomatic HTRs diagnosed via screening CTs. Serum GM was positive only in one of the symptomatic cases. The negative predictive value of CT scans was 100% (95% confidence interval, 71.5%-100%). CONCLUSIONS In an outbreak setting, screening CT scans of the chest may aid in early detection of asymptomatic HTRs with IA and improve outcome.
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Affiliation(s)
- Dima Kabbani
- Division of Infectious Diseases, University of Toronto, University Health Network, Toronto General Hospital, Toronto, ON, Canada.,Division of Infectious Diseases, University of Alberta, Edmonton, AB, Canada
| | - Livia Goldraich
- Division of Cardiology, University Health Network, University of Toronto, Toronto, ON, Canada.,Division of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Heather Ross
- Division of Cardiology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Coleman Rotstein
- Division of Infectious Diseases, University of Toronto, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Shahid Husain
- Division of Infectious Diseases, University of Toronto, University Health Network, Toronto General Hospital, Toronto, ON, Canada
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106
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Bhimji A, Bhaskaran A, Singer LG, Kumar D, Humar A, Pavan R, Lipton J, Kuruvilla J, Schuh A, Yee K, Minden MD, Schimmer A, Rotstein C, Keshavjee S, Mazzulli T, Husain S. Aspergillus galactomannan detection in exhaled breath condensate compared to bronchoalveolar lavage fluid for the diagnosis of invasive aspergillosis in immunocompromised patients. Clin Microbiol Infect 2017; 24:640-645. [PMID: 28970160 DOI: 10.1016/j.cmi.2017.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Exhaled breath condensate (EBC) is a noninvasive means of sampling the airways that has shown significant promise in the diagnosis of many disorders. There have been no reports of its usefulness in the detection of galactomannan (GM), a component of the cell wall of Aspergillus. The suitability of EBC for the detection of GM for the diagnosis of invasive aspergillosis (IA) using the Platelia Aspergillus enzyme-linked immunosorbent assay was investigated. METHODS Prospective, cross-sectional study of lung transplant recipient and haemotologic malignancy patients at a university centre. EBC samples were compared to concomitant bronchoalveolar lavage (BAL) samples among lung transplant recipients and healthy controls. EBC was collected over 10 minutes using a refrigerated condenser according to the European Respiratory Society/American Thoracic Society recommendations, with the BAL performed immediately thereafter. RESULTS A total of 476 EBC specimens with 444 matched BAL specimens collected from lung transplant recipients (n = 197) or haemotologic malignancy patients (n = 133) were examined. Both diluted and untreated EBC optical density (OD) values (0.0830, interquartile range (IQR) 0.0680-0.1040; and 0.1130, IQR 0.0940-0.1383), respectively, from all patients regardless of clinical syndrome were significantly higher than OD values in healthy control EBCs (0.0508, IQR 0.0597-0.0652; p < 0.0001). However, the OD index values did not correlate with the diagnosis of IA (44 samples were associated with IA). Furthermore, no significant correlation was found between EBC GM and the matched BAL specimen. CONCLUSIONS GM is detectable in EBC; however, no correlation between OD index values and IA was noted in lung transplant recipients.
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Affiliation(s)
- A Bhimji
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - A Bhaskaran
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - L G Singer
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - D Kumar
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - A Humar
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - R Pavan
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - J Lipton
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - J Kuruvilla
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - A Schuh
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - K Yee
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - M D Minden
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - A Schimmer
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - C Rotstein
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - S Keshavjee
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - T Mazzulli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - S Husain
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada.
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108
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Ammerman E, Sweet SC, Fenchel M, Storch GA, Conrad C, Hayes D, Faro A, Goldfarb S, Melicoff E, Schecter M, Visner G, Williams NM, Danziger-Isakov L. Risk and outcomes of pulmonary fungal infection after pediatric lung transplantation. Clin Transplant 2017; 31. [PMID: 28871606 DOI: 10.1111/ctr.13100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Prospective studies to determine associated risk factors and related outcomes for pulmonary fungal infection (PFI) after pediatric lung transplant (PLT) are lacking. METHODS NIH-sponsored Clinical Trials in Organ Transplantation in Children enrolled PLT candidates, collecting data prospectively for 2 years post-transplant. Demographics, signs/symptoms, radiology, pathology and microbiology were collected. Analyses evaluated for PFI-related risks and outcomes. RESULTS In 59 PLT, pre-transplant fungal colonization occurred in 6 donors and 15 recipients. Cystic fibrosis (CF) was associated with pre-transplant colonization (P < .01). Twenty-five (42%) PLT had 26 post-transplant colonizations (median = 67 days, range = 0-750 days) with Candida (13), Aspergillus (4), mold (6) or yeast (3). Post-PLT colonization was not associated with CF, age, or pre-PLT colonization. Thirteen PFIs occurred in 10 (17%) patients, 3 proven (Candida species) and 10 probable (Candida [3], Aspergillus [3], Penicillium [3], and mold [1]). Pulmonary fungal infection was preceded by post-PLT colonization with the same organism in 4 of 13 PFI, but post-PLT colonization did not predict subsequent PFI (P = .87). Older age at transplant was a risk for PFI (P < .01). No mortality was attributed to PFI. Prophylaxis use was not associated with decreased post-PLT colonization (P = .60) or PFI (P = .48). CONCLUSION In PLT, PFI and fungal colonization are common but without associated mortality. Post-PLT colonization did not predict PFI. Optimal prevention strategies require additional study.
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Affiliation(s)
- Evan Ammerman
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Matthew Fenchel
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Carol Conrad
- Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Don Hayes
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Albert Faro
- Washington University in St. Louis, St. Louis, MO, USA
| | | | | | - Marc Schecter
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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109
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Opportunistic Pulmonary Infections in the Solid Organ Transplant Recipient: A Focus on Drug Therapy. Crit Care Nurs Q 2017; 40:399-413. [PMID: 28834861 DOI: 10.1097/cnq.0000000000000176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Immunosuppression required to prevent allograft rejection in the solid organ transplant recipient increases vulnerability to infections. Given continuous environmental exposure, the lungs are increasingly susceptible to bacterial, viral, and fungal opportunistic infections. Drug therapy options for the treatment of opportunistic pulmonary infections are used infrequently. These medications are often classified as high risk with specific administration instructions, as well as a multitude of toxicities. Therefore, in this article, we will discuss select pulmonary opportunistic infections and their associated drug therapies.
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110
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Parize P, Boussaud V, Poinsignon V, Sitterlé E, Botterel F, Lefeuvre S, Guillemain R, Dannaoui E, Billaud EM. Clinical outcome of cystic fibrosis patients colonized by Scedosporium
species following lung transplantation: A single-center 15-year experience. Transpl Infect Dis 2017; 19. [DOI: 10.1111/tid.12738] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/01/2017] [Accepted: 03/26/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Perrine Parize
- Department of Mycology; AP-HP; Hôpital Européen Georges Pompidou; Paris France
- Paris Descartes University; Paris France
| | - Veronique Boussaud
- Department of Cardiovascular Surgery and Organ Transplantation; AP-HP; Hôpital Européen Georges Pompidou; Paris France
| | - Vianney Poinsignon
- Department of Pharmacology; AP-HP; Hôpital Européen Georges Pompidou; Paris France
| | - Emilie Sitterlé
- Department of Mycology; AP-HP; Groupe Hospitalier Chenevier-Mondor; Créteil France
- Paris-Est Créteil Val-de-Marne University; Paris France
| | - Francoise Botterel
- Department of Mycology; AP-HP; Groupe Hospitalier Chenevier-Mondor; Créteil France
- Paris-Est Créteil Val-de-Marne University; Paris France
| | - Sandrine Lefeuvre
- Paris Descartes University; Paris France
- Department of Pharmacology; AP-HP; Hôpital Européen Georges Pompidou; Paris France
| | - Romain Guillemain
- Department of Cardiovascular Surgery and Organ Transplantation; AP-HP; Hôpital Européen Georges Pompidou; Paris France
| | - Eric Dannaoui
- Department of Mycology; AP-HP; Hôpital Européen Georges Pompidou; Paris France
- Paris Descartes University; Paris France
| | - Eliane M. Billaud
- Paris Descartes University; Paris France
- Department of Pharmacology; AP-HP; Hôpital Européen Georges Pompidou; Paris France
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111
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Suberviola B, Rellan L, Riera J, Iranzo R, Garcia Campos A, Robles JC, Vicente R, Miñambres E, Santibanez M. Role of biomarkers in early infectious complications after lung transplantation. PLoS One 2017; 12:e0180202. [PMID: 28704503 PMCID: PMC5509107 DOI: 10.1371/journal.pone.0180202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 06/12/2017] [Indexed: 11/18/2022] Open
Abstract
Background Infections and primary graft dysfunction are devastating complications in the immediate postoperative period following lung transplantation. Nowadays, reliable diagnostic tools are not available. Biomarkers could improve early infection diagnosis. Methods Multicentre prospective observational study that included all centres authorized to perform lung transplantation in Spain. Lung infection and/or primary graft dysfunction presentation during study period (first postoperative week) was determined. Biomarkers were measured on ICU admission and daily till ICU discharge or for the following 6 consecutive postoperative days. Results We included 233 patients. Median PCT levels were significantly lower in patients with no infection than in patients with Infection on all follow up days. PCT levels were similar for PGD grades 1 and 2 and increased significantly in grade 3. CRP levels were similar in all groups, and no significant differences were observed at any study time point. In the absence of PGD grade 3, PCT levels above median (0.50 ng/ml on admission or 1.17 ng/ml on day 1) were significantly associated with more than two- and three-fold increase in the risk of infection (adjusted Odds Ratio 2.37, 95% confidence interval 1.06 to 5.30 and 3.44, 95% confidence interval 1.52 to 7.78, respectively). Conclusions In the absence of severe primary graft dysfunction, procalcitonin can be useful in detecting infections during the first postoperative week. PGD grade 3 significantly increases PCT levels and interferes with the capacity of PCT as a marker of infection. PCT was superior to CRP in the diagnosis of infection during the study period.
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Affiliation(s)
- Borja Suberviola
- Critical Care Department, Hospital Universitario Marqués de Valdecilla – IDIVAL, Santander, Spain
- * E-mail:
| | - Luzdivina Rellan
- Department of Anesthesiology, Complexo Hospitalario Universitario A Coruna, A Coruna, Spain
| | - Jordi Riera
- Critical Care Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Reyes Iranzo
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Juan Carlos Robles
- Transplant Coordination Unit, Hospital Universitario Reina Sofia, Cordoba, Spain
| | - Rosario Vicente
- Department of Anesthesiology, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | - Eduardo Miñambres
- Critical Care Department - Transplant Coordination Unit, Hospital Universitario Marques de Valdecilla – IDIVAL, Santander, Spain
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112
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Peghin M, Hirsch HH, Len Ó, Codina G, Berastegui C, Sáez B, Solé J, Cabral E, Solé A, Zurbano F, López‐Medrano F, Román A, Gavaldá J. Epidemiology and Immediate Indirect Effects of Respiratory Viruses in Lung Transplant Recipients: A 5-Year Prospective Study. Am J Transplant 2017; 17:1304-1312. [PMID: 27615811 PMCID: PMC7159570 DOI: 10.1111/ajt.14042] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/23/2016] [Accepted: 09/01/2016] [Indexed: 01/25/2023]
Abstract
The epidemiology of respiratory viruses (RVs) in lung transplant recipients (LTRs) and the relationship of RVs to lung function, acute rejection (AR) and opportunistic infections in these patients are not well known. We performed a prospective cohort study (2009-2014) by collecting nasopharyngeal swabs (NPSs) from asymptomatic LTRs during seasonal changes and from LTRs with upper respiratory tract infectious disease (URTID), lower respiratory tract infectious disease (LRTID) and AR. NPSs were analyzed by multiplex polymerase chain reaction. Overall, 1094 NPSs were collected from 98 patients with a 23.6% positivity rate and mean follow-up of 3.4 years (interquartile range 2.5-4.0 years). Approximately half of URTIDs (47 of 97, 48.5%) and tracheobronchitis cases (22 of 56, 39.3%) were caused by picornavirus, whereas pneumonia was caused mainly by paramyxovirus (four of nine, 44.4%) and influenza (two of nine, 22.2%). In LTRs with LRTID, lung function changed significantly at 1 mo (p = 0.03) and 3 mo (p = 0.04). In a nested case-control analysis, AR was associated with RVs (hazard ratio [HR] 6.54), Pseudomonas aeruginosa was associated with LRTID (HR 8.54), and cytomegalovirus (CMV) replication or disease was associated with URTID (HR 2.53) in the previous 3 mo. There was no association between RVs and Aspergillus spp. colonization or infection (HR 0.71). In conclusion, we documented a high incidence of RV infections in LTRs. LRTID produced significant lung function abnormalities. Associations were observed between AR and RVs, between P. aeruginosa colonization or infection and LRTID, and between CMV replication or disease and URTID.
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Affiliation(s)
- M. Peghin
- Department of Infectious DiseasesHospital Universitari de la Vall d'HebronBarcelonaSpain,Spanish Network for Research in Infectious Diseases (REIPI)SevilleSpain
| | - H. H. Hirsch
- Transplantation & Clinical VirologyDepartment Biomedicine (Haus Petersplatz)University of BaselBaselSwitzerland,Division Infection DiagnosticsDepartment Biomedicine (Haus Petersplatz)University of BaselBaselSwitzerland,Infectious Diseases & Hospital EpidemiologyUniversity Hospital BaselBaselSwitzerland
| | - Ó. Len
- Department of Infectious DiseasesHospital Universitari de la Vall d'HebronBarcelonaSpain,Spanish Network for Research in Infectious Diseases (REIPI)SevilleSpain
| | - G. Codina
- Spanish Network for Research in Infectious Diseases (REIPI)SevilleSpain,Department of MicrobiologyHospital Universitari de la Vall d'HebronBarcelonaSpain
| | - C. Berastegui
- Department of Pulmonology and Lung Transplant UnitHospital Universitari de la Vall d'HebronBarcelonaSpain,CIBER de Enfermedades Respiratorias (CIBERES)Instituto de Salud Carlos IIIMadridSpain
| | - B. Sáez
- Department of Pulmonology and Lung Transplant UnitHospital Universitari de la Vall d'HebronBarcelonaSpain,CIBER de Enfermedades Respiratorias (CIBERES)Instituto de Salud Carlos IIIMadridSpain
| | - J. Solé
- Department of Thoracic SurgeryHospital Universitari de la Vall d'HebronBarcelonaSpain
| | - E. Cabral
- Department of Infectious DiseasesHospital Universitari de la Vall d'HebronBarcelonaSpain
| | - A. Solé
- Spanish Network for Research in Infectious Diseases (REIPI)SevilleSpain,Lung Transplant UnitHospital Universitario y Politécnico La FeValenciaSpain
| | - F. Zurbano
- Spanish Network for Research in Infectious Diseases (REIPI)SevilleSpain,Division of PneumologyHospital Universitario Marqués de ValdecillaIDIVALUniversity of CantabriaSantanderSpain
| | - F. López‐Medrano
- Spanish Network for Research in Infectious Diseases (REIPI)SevilleSpain,Department of Infectious DiseasesHospital Universitario 12 de OctubreMadridSpain
| | - A. Román
- Infectious Diseases & Hospital EpidemiologyUniversity Hospital BaselBaselSwitzerland,CIBER de Enfermedades Respiratorias (CIBERES)Instituto de Salud Carlos IIIMadridSpain
| | - J. Gavaldá
- Department of Infectious DiseasesHospital Universitari de la Vall d'HebronBarcelonaSpain,Spanish Network for Research in Infectious Diseases (REIPI)SevilleSpain
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113
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Kabbani D, Bhaskaran A, Singer LG, Bhimji A, Rotstein C, Keshavjee S, Liles WC, Husain S. Pentraxin 3 levels in bronchoalveolar lavage fluid of lung transplant recipients with invasive aspergillosis. J Heart Lung Transplant 2017; 36:973-979. [PMID: 28487045 DOI: 10.1016/j.healun.2017.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 04/03/2017] [Accepted: 04/17/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Invasive aspergillosis is the most common invasive fungal infection in lung transplant recipients. The use of galactomannan testing in bronchoalveolar lavage (BAL) fluid has improved diagnosis of invasive aspergillosis; however, false-positive results can lead to overdiagnosis and unnecessary treatment. The use of proinflammatory markers such as pentraxin 3 (PTX3) may help differentiate between Aspergillus colonization and disease. METHODS BAL PTX3 concentrations were measured by enzyme-linked immunosorbent assay in 151 lung transplant recipients and 9 healthy control subjects. Patients were characterized as having Aspergillus colonization or invasive disease according to International Society of Heart and Lung Transplantation criteria. Concomitant PTX3values were compared using Mann-Whitney U and Kruskal-Wallis tests. RESULTS We analyzed 322 BAL stored samples and identified 15 invasive aspergillosis events, 38 Aspergillus colonizations, and 17 positive galactomannan with negative Aspergillus cultures. Median BAL PTX3 level was significantly higher in patients with invasive aspergillosis compared with patients with Aspergillus colonization and healthy control subjects (439.20 pg/ml [interquartile range (IQR) 168.18-778.90], 68.93 pg/ml [IQR 13.67-156.74], and 13.67 pg/ml [IQR 13.67-121.18]; p < 0.001). Patients with BAL PTX3 value >319 pg/ml with positive galactomannan and patients with BAL PTX3 value >312 pg/ml with positive Aspergillus culture were 4.5 and 5.5 times more likely to have invasive pulmonary aspergillosis, respectively. CONCLUSIONS Our study shows that PTX3 measurements in BAL samples were significantly higher among patients with invasive aspergillosis and may help to identify patients with Aspergillus colonization and false-positive galactomannan in BAL samples.
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Affiliation(s)
- Dima Kabbani
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Archana Bhaskaran
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Lianne G Singer
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alyajahan Bhimji
- Division of Infectious Diseases, Department of Medicine, Multi-Organ Transplant Program, University of Toronto, Toronto, Ontario, Canada
| | - Coleman Rotstein
- Division of Infectious Diseases, Department of Medicine, Multi-Organ Transplant Program, University of Toronto, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - W Conrad Liles
- Department of Medicine, University of Washington, Seattle, Washington
| | - Shahid Husain
- Division of Infectious Diseases, Department of Medicine, Multi-Organ Transplant Program, University of Toronto, Toronto, Ontario, Canada.
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114
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Jeong W, Snell GI, Levvey BJ, Westall GP, Morrissey CO, Ivulich S, Neoh CF, Slavin MA, Kong DCM. Clinical effectiveness of early posaconazole suspension pre-emptive therapy in lung transplant recipients: The Alfred’s experience. J Antimicrob Chemother 2017; 72:2089-2092. [DOI: 10.1093/jac/dkx085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/23/2017] [Indexed: 12/15/2022] Open
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115
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Kovats Z, Bohacs A, Sutto Z, Vincze K, Lukacsovits J, Losonczy G, Müller V. Seasonal changes of lower respiratory tract infections in lung transplant recipients during the first post-transplant year: The Hungarian experience. Transpl Infect Dis 2017; 19. [PMID: 28164439 DOI: 10.1111/tid.12671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/08/2016] [Accepted: 10/23/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND After lung transplantation (LuTX) a high level of immunosuppression is needed to prevent rejection of the graft. Together with earlier colonization by pathogens, immunosuppression makes recipients more susceptible to infections, especially during the first postoperative year. As seasonality of lower respiratory tract infections (LRTI) is well-known in chronic lung diseases, we assessed seasonal changes of pathogen spectrum and number of infections in the first postoperative year in LuTX recipients. METHODS LRTI were analyzed in 28 Hungarian adult LuTX patients. Incidence and spectrum of microorganism causing LRTI were evaluated according to post-transplant time and seasonal temperature and humidity changes. RESULTS A total of 69 cases of LRTI were registered (average: 1.9 cases/patient; range: 0-14). Gram-negative=59, gram-positive=26, and fungal=31 pathogens were detected, with polymicrobial samples in 46% of all cases. Increased number of LRTI was observed in the cold season (1.68±1.54 vs 0.79±0.92 case/month/patient, P<.01) and significant negative correlations were identified between the incidence of polymicrobial and bacterial infections and temperature (r2 =0.1535, P<.05, r2 =0.3144, P<.01, respectively). In addition, positive correlation was observed between polymicrobial infections and humidity (r2 =0.1403, P<.05). Higher incidence of LRTI was also noted in the cold season, when accounting for the differences in immunosuppression. CONCLUSION Seasons influenced the incidence of LRTI in the first postoperative year in LuTX recipients. More intensive vigilance for possible gram-negative and polymicrobial infections is needed in these patients in cold and wet seasons in the continental climate zone, regardless of underlying disease.
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Affiliation(s)
- Zsuzsanna Kovats
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Aniko Bohacs
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Zoltan Sutto
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Krisztina Vincze
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Gyorgy Losonczy
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
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116
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Pilarczyk K, Haake N, Heckmann J, Carstens H, Haneya A, Cremer J, Jakob H, Pizanis N, Kamler M. Is universal antifungal prophylaxis mandatory in adults after lung transplantation? A review and meta-analysis of observational studies. Clin Transplant 2016; 30:1522-1531. [PMID: 27653443 DOI: 10.1111/ctr.12854] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Kevin Pilarczyk
- Department of Intensive Care Medicine; imland Klinik Rendsburg; Rendsburg Germany
- Department of Thoracic and Cardiovascular Surgery; West German Heart and Vascular Center Essen; University Hospital Essen; Essen Germany
| | - Nils Haake
- Department of Intensive Care Medicine; imland Klinik Rendsburg; Rendsburg Germany
| | - Jens Heckmann
- Department of Thoracic and Cardiovascular Surgery; West German Heart and Vascular Center Essen; University Hospital Essen; Essen Germany
| | - Henning Carstens
- Department of Thoracic and Cardiovascular Surgery; West German Heart and Vascular Center Essen; University Hospital Essen; Essen Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery; University of Schleswig-Holstein; Kiel Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery; University of Schleswig-Holstein; Kiel Germany
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery; West German Heart and Vascular Center Essen; University Hospital Essen; Essen Germany
| | - Nikolaus Pizanis
- Department of Thoracic and Cardiovascular Surgery; West German Heart and Vascular Center Essen; University Hospital Essen; Essen Germany
| | - Markus Kamler
- Department of Thoracic and Cardiovascular Surgery; West German Heart and Vascular Center Essen; University Hospital Essen; Essen Germany
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117
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Bhaskaran A, Kabbani D, Singer LG, Prochnow T, Bhimji A, Rotstein C, Finkelman MA, Keshavjee S, Husain S. (1,3) β-D-Glucan in Bronchoalveolar Lavage of Lung Transplant Recipients for the Diagnosis of Invasive Pulmonary Aspergillosis. Med Mycol 2016; 55:173-179. [DOI: 10.1093/mmy/myw052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 12/30/2015] [Accepted: 05/08/2016] [Indexed: 11/13/2022] Open
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118
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Shankar J, Nguyen MH, Crespo MM, Kwak EJ, Lucas SK, McHugh KJ, Mounaud S, Alcorn JF, Pilewski JM, Shigemura N, Kolls JK, Nierman WC, Clancy CJ. Looking Beyond Respiratory Cultures: Microbiome-Cytokine Signatures of Bacterial Pneumonia and Tracheobronchitis in Lung Transplant Recipients. Am J Transplant 2016; 16:1766-78. [PMID: 26693965 DOI: 10.1111/ajt.13676] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/10/2015] [Accepted: 12/06/2015] [Indexed: 01/25/2023]
Abstract
Bacterial pneumonia and tracheobronchitis are diagnosed frequently following lung transplantation. The diseases share clinical signs of inflammation and are often difficult to differentiate based on culture results. Microbiome and host immune-response signatures that distinguish between pneumonia and tracheobronchitis are undefined. Using a retrospective study design, we selected 49 bronchoalveolar lavage fluid samples from 16 lung transplant recipients associated with pneumonia (n = 8), tracheobronchitis (n = 12) or colonization without respiratory infection (n = 29). We ensured an even distribution of Pseudomonas aeruginosa or Staphylococcus aureus culture-positive samples across the groups. Bayesian regression analysis identified non-culture-based signatures comprising 16S ribosomal RNA microbiome profiles, cytokine levels and clinical variables that characterized the three diagnoses. Relative to samples associated with colonization, those from pneumonia had significantly lower microbial diversity, decreased levels of several bacterial genera and prominent multifunctional cytokine responses. In contrast, tracheobronchitis was characterized by high microbial diversity and multifunctional cytokine responses that differed from those of pneumonia-colonization comparisons. The dissimilar microbiomes and cytokine responses underlying bacterial pneumonia and tracheobronchitis following lung transplantation suggest that the diseases result from different pathogenic processes. Microbiomes and cytokine responses had complementary features, suggesting that they are closely interconnected in the pathogenesis of both diseases.
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Affiliation(s)
- J Shankar
- J. Craig Venter Institute, Rockville, MD
| | - M H Nguyen
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - M M Crespo
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - E J Kwak
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - S K Lucas
- J. Craig Venter Institute, Rockville, MD
| | - K J McHugh
- Department of Pediatrics, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - S Mounaud
- J. Craig Venter Institute, Rockville, MD
| | - J F Alcorn
- Department of Pediatrics, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - J M Pilewski
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - N Shigemura
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - J K Kolls
- Richard King Mellon Foundation Institute for Pediatric Research, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - C J Clancy
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.,VA Pittsburgh Healthcare System, Division of Infectious Diseases, Pittsburgh, PA
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119
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Husain S, Sole A, Alexander BD, Aslam S, Avery R, Benden C, Billaud EM, Chambers D, Danziger-Isakov L, Fedson S, Gould K, Gregson A, Grossi P, Hadjiliadis D, Hopkins P, Luong ML, Marriott DJ, Monforte V, Muñoz P, Pasqualotto AC, Roman A, Silveira FP, Teuteberg J, Weigt S, Zaas AK, Zuckerman A, Morrissey O. The 2015 International Society for Heart and Lung Transplantation Guidelines for the management of fungal infections in mechanical circulatory support and cardiothoracic organ transplant recipients: Executive summary. J Heart Lung Transplant 2016; 35:261-282. [DOI: 10.1016/j.healun.2016.01.007] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/10/2016] [Indexed: 01/10/2023] Open
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120
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Robinson C, Chau C, Yerkovich S, Azzopardi M, Hopkins P, Chambers D. Posaconazole in lung transplant recipients: use, tolerability, and efficacy. Transpl Infect Dis 2016; 18:302-8. [DOI: 10.1111/tid.12497] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/04/2015] [Accepted: 11/01/2015] [Indexed: 11/29/2022]
Affiliation(s)
- C.L. Robinson
- Toowoomba Base Hospital; Toowoomba Queensland Australia
| | - C. Chau
- School of Pharmacy; The University of Queensland; Brisbane Queensland Australia
| | - S.T. Yerkovich
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
- Queensland Lung Transplant Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - M. Azzopardi
- Queensland Lung Transplant Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - P. Hopkins
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
- Queensland Lung Transplant Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - D. Chambers
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
- Queensland Lung Transplant Service; The Prince Charles Hospital; Brisbane Queensland Australia
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121
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Langford S, Trubiano JA, Saxon S, Spelman D, Morrissey CO. Mucormycete infection or colonisation: experience of an Australian tertiary referral centre. Mycoses 2016; 59:291-5. [PMID: 26857435 DOI: 10.1111/myc.12467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 12/30/2022]
Abstract
Mucormycosis is associated with significant morbidity and mortality. We reviewed patients with mucormycete isolated at Alfred Health, Australia. A retrospective review of 66 patients with mucormycete(s) identified, between 1 April 2008 and 30 June 2014. Baseline demographic, microbiological, radiological, treatment/outcome data were recorded. Site of isolation was sinopulmonary in 77% and skin/soft tissue in 21%. A total of 32% of cases were proven-IFD, 12% probable-IFD and 56% were defined as no-IFD (or colonisation). Rhizopus spp. was identified in 48%. Comparing probable/proven-IFD with no-IFD/colonisation, more patients were postallogeneic stem cell transplantation (28% vs. 0%, P < 0.01) and were receiving immunosuppressive therapy (59% vs. 24%, P < 0.01) including prednisolone >20 mg daily (24% vs. 5%, P = 0.04). A total of 93% of patients with proven/probable IFD received treatment while 30% of no-IFD/colonisation were treated. A total of 72% of patients with proven/probable IFD and 92% of those with colonisation had no further mucormycete isolated. Thirty day mortality was higher in the proven/probable-IFD cohort (24%) compared with no-IFD/colonisation (3%) (P = 0.02). Mucormycosis remains uncommon, with 56% of cases not associated with clinical infection. Immunosuppressive therapy remains strongly associated with mucormycosis. Mortality remains high in those with proven/probable IFD.
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Affiliation(s)
- S Langford
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Vic., Australia
| | - J A Trubiano
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Vic., Australia.,Department of Microbiology, Alfred Health and Monash University, Melbourne, Vic., Australia
| | - S Saxon
- Department of Pathology, Alfred Health, Melbourne, Vic., Australia
| | - D Spelman
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Vic., Australia.,Department of Microbiology, Alfred Health and Monash University, Melbourne, Vic., Australia
| | - C O Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Vic., Australia
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122
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Peghin M, Monforte V, Martin-Gomez M, Ruiz-Camps I, Berastegui C, Saez B, Riera J, Solé J, Gavaldá J, Roman A. Epidemiology of invasive respiratory disease caused by emerging non-Aspergillusmolds in lung transplant recipients. Transpl Infect Dis 2016; 18:70-8. [DOI: 10.1111/tid.12492] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/21/2015] [Accepted: 10/13/2015] [Indexed: 01/22/2023]
Affiliation(s)
- M. Peghin
- Department of Infectious Diseases; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
- Department of Medicine; Universitat Autònoma de Barcelona; Barcelona Spain
| | - V. Monforte
- Department of Pulmonology and Lung Transplant Unit; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
- Ciber Enfermedades Respiratorias (CIBERES); Instituto de Salud Carlos III; Madrid Spain
| | - M.T. Martin-Gomez
- Department of Microbiology; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
| | - I. Ruiz-Camps
- Department of Infectious Diseases; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
- Department of Medicine; Universitat Autònoma de Barcelona; Barcelona Spain
| | - C. Berastegui
- Department of Pulmonology and Lung Transplant Unit; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
- Ciber Enfermedades Respiratorias (CIBERES); Instituto de Salud Carlos III; Madrid Spain
| | - B. Saez
- Department of Pulmonology and Lung Transplant Unit; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
- Ciber Enfermedades Respiratorias (CIBERES); Instituto de Salud Carlos III; Madrid Spain
| | - J. Riera
- Department of Intensive Care Unit; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
| | - J. Solé
- Department of Thoracic Surgery; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
| | - J. Gavaldá
- Department of Infectious Diseases; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
- Department of Medicine; Universitat Autònoma de Barcelona; Barcelona Spain
| | - A. Roman
- Department of Pulmonology and Lung Transplant Unit; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
- Ciber Enfermedades Respiratorias (CIBERES); Instituto de Salud Carlos III; Madrid Spain
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123
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Tebano G, Geneve C, Tanaka S, Grall N, Atchade E, Augustin P, Thabut G, Castier Y, Montravers P, Desmard M. Epidemiology and risk factors of multidrug-resistant bacteria in respiratory samples after lung transplantation. Transpl Infect Dis 2016; 18:22-30. [DOI: 10.1111/tid.12471] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/23/2015] [Accepted: 09/12/2015] [Indexed: 11/27/2022]
Affiliation(s)
- G. Tebano
- Département d'Anesthésie Réanimation; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
| | - C. Geneve
- Département d'Anesthésie Réanimation; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
| | - S. Tanaka
- Service de Réanimation; Centre Hospitalier Victor Dupouy; Argenteuil France
| | - N. Grall
- Laboratoire de Microbiologie; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
| | - E. Atchade
- Département d'Anesthésie Réanimation; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
| | - P. Augustin
- Département d'Anesthésie Réanimation; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
| | - G. Thabut
- Service de Pneumologie B et Transplantation Pulmonaire; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
- Physiopathologie et Epidémiologie des Maladies Respiratoires; Université Paris Diderot Sorbonne Cite; Inserm UMR1152; Paris France
| | - Y. Castier
- Physiopathologie et Epidémiologie des Maladies Respiratoires; Université Paris Diderot Sorbonne Cite; Inserm UMR1152; Paris France
- Service de Chirurgie Thoracique et Vasculaire; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
| | - P. Montravers
- Département d'Anesthésie Réanimation; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
- Physiopathologie et Epidémiologie des Maladies Respiratoires; Université Paris Diderot Sorbonne Cite; Inserm UMR1152; Paris France
| | - M. Desmard
- Département d'Anesthésie Réanimation; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
- Service de Réanimation; Centre Hospitalier Sud Francilien; Corbeil-Essonnes France
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124
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Risks and Epidemiology of Infections After Lung or Heart–Lung Transplantation. TRANSPLANT INFECTIONS 2016. [PMCID: PMC7123746 DOI: 10.1007/978-3-319-28797-3_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nowadays, lung transplantation is an established treatment option of end-stage pulmonary parenchymal and vascular disease. Post-transplant infections are a significant contributor to overall morbidity and mortality in the lung transplant recipient that, in turn, are higher than in other solid organ transplant recipients. This is likely due to several specific factors such as the constant exposure to the outside environment and the colonized native airway, and the disruption of usual mechanisms of defense including the cough reflex, bronchial circulation, and lymphatic drainage. This chapter will review the common infections that develop in the lung or heart–lung transplant recipient, including the general risk factors for infection in this population, and specific features of prophylaxis and treatment for the most frequent bacterial, viral, and fungal infections. The effects of infection on lung transplant rejection will also be discussed.
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125
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Bonnal C, Leleu C, Brugière O, Chochillon C, Porcher R, Boelle PY, Menotti J, Houze S, Lucet JC, Derouin F. Relationship between Fungal Colonisation of the Respiratory Tract in Lung Transplant Recipients and Fungal Contamination of the Hospital Environment. PLoS One 2015; 10:e0144044. [PMID: 26629994 PMCID: PMC4667873 DOI: 10.1371/journal.pone.0144044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/12/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Aspergillus colonisation is frequently reported after lung transplantation. The question of whether aspergillus colonisation is related to the hospital environment is crucial to prevention. METHOD To elucidate this question, a prospective study of aspergillus colonisation after lung transplantation, along with a mycological survey of the patient environment, was performed. RESULTS Forty-four consecutive patients were included from the day of lung transplantation and then examined weekly for aspergillus colonisation until hospital discharge. Environmental fungal contamination of each patient was followed weekly via air and surface sampling. Twelve patients (27%) had transient aspergillus colonisation, occurring 1-13 weeks after lung transplantation, without associated manifestation of aspergillosis. Responsible Aspergillus species were A. fumigatus (6), A. niger (3), A. sydowii (1), A. calidoustus (1) and Aspergillus sp. (1). In the environment, contamination by Penicillium and Aspergillus was predominant. Multivariate analysis showed a significant association between occurrence of aspergillus colonisation and fungal contamination of the patient's room, either by Aspergillus spp. in the air or by A.fumigatus on the floor. Related clinical and environmental isolates were genotyped in 9 cases of aspergillus colonisation. For A. fumigatus (4 cases), two identical microsatellite profiles were found between clinical and environmental isolates collected on distant dates or locations. For other Aspergillus species, isolates were different in 2 cases; in 3 cases of aspergillus colonisation by A. sydowii, A. niger and A. calidoustus, similarity between clinical and environmental internal transcribed spacer and tubulin sequences was >99%. CONCLUSION Taken together, these results support the hypothesis of environmental risk of hospital acquisition of aspergillus colonisation in lung transplant recipients.
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Affiliation(s)
- Christine Bonnal
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, F-75018, Paris, France
| | - Christopher Leleu
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
- University Pierre et Marie Curie-Paris 6, Paris, France
| | - Olivier Brugière
- AP-HP, Service de Pneumologie B, Unité de Transplantation Pulmonaire, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
| | - Christian Chochillon
- AP-HP, Laboratory of Parasitology and Mycology, Bichat-Claude Bernard University Hospital, Paris, France
| | - Raphael Porcher
- Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité, UMR 1153, Inserm, Université Paris Descartes, Paris, France
| | - Pierre-Yves Boelle
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique–U1136, Paris, France
| | - Jean Menotti
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, F-75018, Paris, France
- AP-HP, Laboratory of Parasitology and Mycology, Saint-Louis University Hospital, Paris, France
| | - Sandrine Houze
- AP-HP, Laboratory of Parasitology and Mycology, Bichat-Claude Bernard University Hospital, Paris, France
- UMR 216, Mère et enfants face aux infections tropicales, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris, France
| | - Jean-Christophe Lucet
- University Pierre et Marie Curie-Paris 6, Paris, France
- Paris Diderot University, IAME, UMR 1137, F-75018 Paris, France
| | - Francis Derouin
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, F-75018, Paris, France
- AP-HP, Laboratory of Parasitology and Mycology, Saint-Louis University Hospital, Paris, France
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The Effectiveness of Culture-Directed Preemptive Anti-Aspergillus Treatment in Lung Transplant Recipients at One Year After Transplant. Transplantation 2015; 99:2387-93. [DOI: 10.1097/tp.0000000000000743] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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127
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Peghin M, Monforte V, Martin-Gomez MT, Ruiz-Camps I, Berastegui C, Saez B, Riera J, Ussetti P, Solé J, Gavaldá J, Roman A. 10 years of prophylaxis with nebulized liposomal amphotericin B and the changing epidemiology ofAspergillusspp. infection in lung transplantation. Transpl Int 2015; 29:51-62. [DOI: 10.1111/tri.12679] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/06/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Maddalena Peghin
- Department of Infectious Diseases; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
- Department of Medicine; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Victor Monforte
- Department of Pulmonology and Lung Transplant Unit; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
- Ciber Enfermedades Respiratorias (CIBERES); Instituto de Salud Carlos III; Madrid Spain
| | | | - Isabel Ruiz-Camps
- Department of Infectious Diseases; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
- Department of Medicine; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Cristina Berastegui
- Department of Pulmonology and Lung Transplant Unit; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
- Ciber Enfermedades Respiratorias (CIBERES); Instituto de Salud Carlos III; Madrid Spain
| | - Berta Saez
- Department of Pulmonology and Lung Transplant Unit; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
- Ciber Enfermedades Respiratorias (CIBERES); Instituto de Salud Carlos III; Madrid Spain
| | - Jordi Riera
- Department of Intensive Care Unit; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
| | - Piedad Ussetti
- Department of Pulmonology and Lung Transplant Unit; Hospital Puerta del Hierro; Madrid Spain
| | - Juan Solé
- Department of Thoracic Surgery; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
| | - Joan Gavaldá
- Department of Infectious Diseases; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
- Department of Medicine; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Antonio Roman
- Department of Pulmonology and Lung Transplant Unit; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
- Ciber Enfermedades Respiratorias (CIBERES); Instituto de Salud Carlos III; Madrid Spain
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128
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Metalloproteinase Profiling in Lung Transplant Recipients With Good Outcome and Bronchiolitis Obliterans Syndrome. Transplantation 2015; 99:1946-52. [DOI: 10.1097/tp.0000000000000602] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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129
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Influence of cytomegalovirus infection in the development of cardiac allograft vasculopathy after heart transplantation. J Heart Lung Transplant 2015; 34:1112-9. [DOI: 10.1016/j.healun.2015.03.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 02/16/2015] [Accepted: 03/16/2015] [Indexed: 11/17/2022] Open
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130
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Jamal AJ, Resende MR, Prochnow T, McGilvray I, Pilewski JM, Crespo MM, Singer LG, McCurry KR, Kolls JK, Keshavjee S, Liles WC, Husain S. Simkania negevensis and acute cellular rejection in lung transplant recipients. Clin Transplant 2015; 29:705-11. [PMID: 26009941 DOI: 10.1111/ctr.12571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2015] [Indexed: 12/01/2022]
Abstract
Simkania negevensis infection has been hypothesized to play a role in lung transplant rejection. The incidence of S. negevensis infection and its association with acute cellular rejection (ACR) were determined in a prospective cohort study of 78 lung transplant recipients (LTRs) in Toronto, Canada, and Pittsburgh, USA, from July 2007 to January 2010. Simkania negevensis testing was detected by quantitative polymerase chain reaction (PCR) on bronchoalveolar lavage fluid. The relationship between S. negevensis and ACR was examined using Cox proportional hazards models and generalized linear and latent mixed models. Cumulative incidence estimates for time-to-ACR in S. negevensis PCR-positive vs. PCR-negative LTRs were 52.7% vs. 31.1% at six months and 68.9% vs. 44.6% at one yr, respectively. Although not statistically significant, there was a trend toward a higher risk of ACR among S. negevensis PCR-positive vs. PCR-negative LTRs in all statistical models.
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Affiliation(s)
- Alainna J Jamal
- Division of Infectious Diseases, Department of Medicine, Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Mariangela R Resende
- Division of Infectious Diseases, Department of Medicine, Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Taisa Prochnow
- Division of Infectious Diseases, Department of Medicine, Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Ian McGilvray
- Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Joseph M Pilewski
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maria M Crespo
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lianne G Singer
- Division of Respirology, Department of Medicine, Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Kenneth R McCurry
- Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jay K Kolls
- Departments of Pediatrics and Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shaf Keshavjee
- Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, ON, Canada
| | - W Conrad Liles
- Division of Infectious Diseases, Department of Medicine, Toronto General Research Institute, McLaughlin-Rotman Centre for Global Health, McLaughlin Centre for Molecular Medicine, University of Toronto, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Shahid Husain
- Division of Infectious Diseases, Department of Medicine, Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, ON, Canada
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131
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Trubiano JA, Chen S, Slavin MA. An Approach to a Pulmonary Infiltrate in Solid Organ Transplant Recipients. CURRENT FUNGAL INFECTION REPORTS 2015; 9:144-154. [PMID: 32218881 PMCID: PMC7091299 DOI: 10.1007/s12281-015-0229-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The onset of a pulmonary infiltrate in a solid organ transplant (SOT) recipient is both a challenging diagnostic and therapeutic challenge. We outline the potential aetiologies of a pulmonary infiltrate in a SOT recipient, with particular attention paid to fungal pathogens. A diagnostic and empirical therapy approach to a pulmonary infiltrate, especially invasive fungal disease (IFD) in SOT recipients, is provided.
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Affiliation(s)
- Jason A. Trubiano
- Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, VIC Australia
- Infectious Diseases, Austin Health, Melbourne, VIC Australia
- Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne, VIC 3002 Australia
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead Hospital, Sydney, Australia
| | - Monica A. Slavin
- Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, VIC Australia
- Infectious Diseases, Royal Melbourne Hospital, Melbourne, VIC Australia
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132
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133
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Andini R, Agrusta F, Mattucci I, Malgeri U, Cavezza G, Utili R, Durante-Mangoni E. Recipient-born bloodstream infection due to extensively drug-resistant Acinetobacter baumannii after emergency heart transplant: report of a case and review of the literature. Infection 2015; 43:609-13. [PMID: 25828937 DOI: 10.1007/s15010-015-0772-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/24/2015] [Indexed: 01/28/2023]
Abstract
Infections due to drug-resistant Gram-negative rods are an emerging risk factor for increased mortality after solid organ transplant. Extensively drug-resistant (XDR) Acinetobacter baumannii (Acb) is a major threat in several critical care settings. The limited available data on the outcome of XDR Acb infections in organ transplant recipients mostly comes from cases of donor-derived infections. However, recipients of life-saving organs are often critically ill patients, staying long term in intensive care units, and therefore at high risk for nosocomial infections. In this report, we describe our experience with the exceedingly complex management of a recipient-born XDR Acb bloodstream infection clinically ensued shortly after heart transplant. We also review the current literature on this mounting issue relevant for intensive care, transplant medicine and infectious diseases.
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Affiliation(s)
- Roberto Andini
- Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy
| | - Federica Agrusta
- Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy
| | - Irene Mattucci
- Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy
| | - Umberto Malgeri
- Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy
| | - Giusi Cavezza
- Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy
| | - Riccardo Utili
- Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy
| | - Emanuele Durante-Mangoni
- Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy.
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Wojtowicz A, Gresnigt MS, Lecompte T, Bibert S, Manuel O, Joosten LAB, Rueger S, Berger C, Boggian K, Cusini A, Garzoni C, Hirsch HH, Weisser M, Mueller NJ, Meylan PR, Steiger J, Kutalik Z, Pascual M, van Delden C, van de Veerdonk FL, Bochud PY, the Swiss Transplant Cohort Study (STCS), Binet I, De Geest S, van Delden C, Hofbauer GFK, Huynh-Do U, Koller MT, Lovis C, Manuel O, Meylan P, Mueller NJ, Pascual M, Schaub S, Steiger J. IL1B and DEFB1 Polymorphisms Increase Susceptibility to Invasive Mold Infection After Solid-Organ Transplantation. J Infect Dis 2014; 211:1646-57. [DOI: 10.1093/infdis/jiu636] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/06/2014] [Indexed: 01/16/2023] Open
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135
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Riera J, Caralt B, López I, Augustin S, Roman A, Gavalda J, Rello J. Ventilator-associated respiratory infection following lung transplantation. Eur Respir J 2014; 45:726-37. [PMID: 25359351 DOI: 10.1183/09031936.00095214] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The medical records of 170 adult patients who underwent lung transplantation between January 2010 and December 2012 were reviewed to assess the incidence, causative organisms, risk factors and outcomes of post-operative pneumonia and tracheobronchitis. 20 (12%) patients suffered 24 episodes of ventilator-associated pneumonia. The condition was associated with mean increases of 43 days in mechanical ventilation and of 35 days in hospital stay, and significantly higher hospital mortality (OR 9.0, 95% CI 3.2-25.1). Pseudomonas aeruginosa (eight out of 12 patients were multidrug-resistant) was the most common pathogen, followed by Enterobacteriaceae (one out of five patients produced extended-spectrum β-lactamases). Gastroparesis occurred in 55 (32%) patients and was significantly associated with pneumonia (OR 6.2, 95% CI 2.2-17.2). Ventilator-associated tracheobronchitis was associated with a mean increase of 28 days in mechanical ventilation and 30.5 days in hospital stay, but was not associated with higher mortality (OR 1.2, 95% CI 0.4-3.2). Pseudomonas aeruginosa (six out of 16 patients were multidrug resistant) was the most common pathogen, followed by Enterobacteriaceae (three out of 14 patients produced extended-spectrum β-lactamase). Patients with gastroparesis also had more episodes of ventilator-associated tracheobronchitis (40% versus 12%, p<0.001). In conclusion, ventilator-associated pneumonia following lung transplantation increased mortality. Preventing gastroparesis probably decreases the risk of pneumonia and tracheobronchitis. Multidrug-resistant bacteria frequently cause post-lung-transplantation pneumonia and tracheobronchitis.
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Affiliation(s)
- Jordi Riera
- Dept of Critical Care, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Berta Caralt
- Dept of Critical Care, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Iker López
- Dept of Thoracic Surgery, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Salvador Augustin
- Liver Unit, Dept of Internal Medicine, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Roman
- Dept of Pneumology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Joan Gavalda
- Dept of Infectious Diseases, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Investigación de Patologías Infecciosas (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Rello
- Dept of Critical Care, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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136
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Aspergillosis in Lung Transplant Patients: Focus on Colonization Pre-transplant and Impact on Invasive Disease. CURRENT FUNGAL INFECTION REPORTS 2014. [DOI: 10.1007/s12281-014-0207-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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137
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Gavaldà J, Meije Y, Fortún J, Roilides E, Saliba F, Lortholary O, Muñoz P, Grossi P, Cuenca-Estrella M. Invasive fungal infections in solid organ transplant recipients. Clin Microbiol Infect 2014; 20 Suppl 7:27-48. [DOI: 10.1111/1469-0691.12660] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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138
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Neoh CF, Snell G, Levvey B, Morrissey CO, Stewart K, Kong DC. Antifungal prophylaxis in lung transplantation. Int J Antimicrob Agents 2014; 44:194-202. [DOI: 10.1016/j.ijantimicag.2014.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 05/12/2014] [Indexed: 10/25/2022]
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139
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[Mold infections in lung transplants]. Rev Iberoam Micol 2014; 31:229-36. [PMID: 25442380 DOI: 10.1016/j.riam.2014.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 07/11/2014] [Indexed: 11/23/2022] Open
Abstract
Invasive infections by molds, mainly Aspergillus infections, account for more than 10% of infectious complications in lung transplant recipients. These infections have a bimodal presentation: an early one, mainly invading bronchial airways, and a late one, mostly focused on lung or disseminated. The Aspergillus colonization at any time in the post-transplant period is one of the major risk factors. Late colonization, together with chronic rejection, is one of the main causes of late invasive forms. A galactomannan value of 0.5 in bronchoalveolar lavage is currently considered a predictive factor of pulmonary invasive infection. There is no universal strategy in terms of prophylaxis. Targeted prophylaxis and preemptive treatment instead of universal prophylaxis, are gaining more followers. The therapeutic drug monitoring level of azoles is highly recommended in the treatment. Monotherapy with voriconazole is the treatment of choice in invasive aspergillosis; combined antifungal therapies are only recommended in severe, disseminated, and other infections due to non-Aspergillus molds.
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140
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Sung EC, Brar LK, Chung E, Kubak B, Carlson M, Deng M, Friedlander AH. Dental treatment in the cardiothoracic intensive care unit for patients with ventricular assist devices awaiting heart transplant: a case series. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:194-201. [DOI: 10.1016/j.oooo.2014.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 04/07/2014] [Accepted: 04/17/2014] [Indexed: 12/01/2022]
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141
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Saito T, Liu M, Binnie M, Sato M, Hwang D, Azad S, Machuca TN, Zamel R, Waddell TK, Cypel M, Keshavjee S. Distinct expression patterns of alveolar "alarmins" in subtypes of chronic lung allograft dysfunction. Am J Transplant 2014; 14:1425-32. [PMID: 24787265 DOI: 10.1111/ajt.12718] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/27/2014] [Accepted: 02/17/2014] [Indexed: 01/25/2023]
Abstract
The long-term success of lung transplantation is limited by chronic lung allograft dysfunction (CLAD). The purpose of this study was to investigate the alveolar alarmin profiles in CLAD subtypes, restrictive allograft syndrome (RAS) and bronchiolitis obliterans syndrome (BOS). Bronchoalveolar lavage (BAL) samples were collected from 53 recipients who underwent double lung or heart-lung transplantation, including patients with RAS (n = 10), BOS (n = 18) and No CLAD (n = 25). Protein levels of alarmins such as S100A8, S100A9, S100A8/A9, S100A12, S100P, high-mobility group box 1 (HMGB1) and soluble receptor for advanced glycation end products (sRAGE) in BAL fluid were measured. RAS and BOS showed higher expressions of S100A8, S100A8/A9 and S100A12 compared with No CLAD (p < 0.0001, p < 0.0001, p < 0.0001 in RAS vs. No CLAD, p = 0.0006, p = 0.0044, p = 0.0086 in BOS vs. No CLAD, respectively). Moreover, RAS showed greater up-regulation of S100A9, S100A8/A9, S100A12, S100P and HMGB1 compared with BOS (p = 0.0094, p = 0.038, p = 0.041, p = 0.035 and p = 0.010, respectively). sRAGE did not show significant difference among the three groups (p = 0.174). Our results demonstrate distinct expression patterns of alveolar alarmins in RAS and BOS, suggesting that RAS and BOS may represent biologically different subtypes. Further refinements in biologic profiling will lead to a better understanding of CLAD.
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Affiliation(s)
- T Saito
- Latner Thoracic Surgery Research Laboratories, Toronto General Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Thoracic and Cardiovascular Surgery, Kansai Medical University, Hirakara, Japan
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142
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Elevated CXCL10 (IP-10) in bronchoalveolar lavage fluid is associated with acute cellular rejection after human lung transplantation. Transplantation 2014; 97:90-7. [PMID: 24025324 DOI: 10.1097/tp.0b013e3182a6ee0a] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND CXCL10 (IP-10) is a potent chemoattractant for T cells that has been postulated to play a role in infection and acute cellular rejection (ACR) in animal models. We measured CXCL10 (IP-10) (and other cytokines previously implicated in the pathogenesis of ACR) in the bronchoalveolar lavage (BAL) of lung transplant recipients (LTRs) to determine the association between CXCL10 (IP-10) and ACR in LTRs. METHODS In a prospective study of 85 LTRs, expression of cytokines (tumor necrosis factor, interferon-γ, interleukin [IL]-6, IL-8, IL-15, IL-16, IL-17, CXCL10 [IP-10], and MCP-1 [CCL2]) in BAL samples (n=233) from patients with episodes of ACR (n=44), infection ("Infect"; n=25), concomitant "Infect+ACR" (n=10), and "No Infect and No ACR" (n=154) were analyzed. RESULTS The levels of both CXCL10 (IP-10) and IL-16 were significantly increased in histologically proven ACR compared with the "No Infect and No ACR" group (CXCL10 [IP-10]: 107.0 vs. 31.9 pg/mL [P=0.001] and IL-16: 472.1 vs. 283.01 pg/mL [P=0.01]). However, in a linear mixed-effects model, significant association was found only between CXCL10 (IP-10) and ACR. A one-log increase of CXCL10 (IP-10) was associated with a 40% higher risk of ACR (odds ratio, 1.4; 95% confidence interval, 1.12-1.84). CONCLUSION Higher values of CXCL10 (IP-10) in BAL fluid are associated with ACR in LTRs, suggesting a potential mechanistic role in the pathogenesis of ACR in LTRs. These results suggest that therapeutic strategies to inhibit CXCL10 (IP-10) and or its cognate receptor, CXCR3, warrant investigation to prevent and/or treat ACR in clinical lung transplantation.
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143
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Clancy CJ, Bartsch SM, Nguyen MH, Stuckey DR, Shields RK, Lee BY. A computer simulation model of the cost-effectiveness of routine Staphylococcus aureus screening and decolonization among lung and heart-lung transplant recipients. Eur J Clin Microbiol Infect Dis 2014; 33:1053-61. [PMID: 24500598 DOI: 10.1007/s10096-013-2046-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/29/2013] [Indexed: 10/25/2022]
Abstract
Our objective was to model the cost-effectiveness and economic value of routine peri-operative Staphylococcus aureus screening and decolonization of lung and heart-lung transplant recipients from hospital and third-party payer perspectives. We used clinical data from 596 lung and heart-lung transplant recipients to develop a model in TreeAge Pro 2009 (Williamsport, MA, USA). Sensitivity analyses varied S. aureus colonization rate (5-15 %), probability of infection if colonized (10-30 %), and decolonization efficacy (25-90 %). Data were collected from the Cardiothoracic Transplant Program at the University of Pittsburgh Medical Center. Consecutive lung and heart-lung transplant recipients from January 2006 to December 2010 were enrolled retrospectively. Baseline rates of S. aureus colonization, infection and decolonization efficacy were 9.6 %, 36.7 %, and 31.9 %, respectively. Screening and decolonization was economically dominant for all scenarios tested, providing more cost savings and health benefits than no screening. Savings per case averted (2012 $US) ranged from $73,567 to $133,157 (hospital perspective) and $10,748 to $16,723 (third party payer perspective), varying with the probability of colonization, infection, and decolonization efficacy. Using our clinical data, screening and decolonization led to cost savings per case averted of $240,602 (hospital perspective) and averted 6.7 S. aureus infections (4.3 MRSA and 2.4 MSSA); 89 patients needed to be screened to prevent one S. aureus infection. Our data support routine S. aureus screening and decolonization of lung and heart-lung transplant patients. The economic value of screening and decolonization was greater than in previous models of other surgical populations.
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Affiliation(s)
- C J Clancy
- Department of Medicine, University of Pittsburgh, 3550 Terrace Street, Scaife Hall 867, Pittsburgh, PA, 15261, USA,
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Bhaskaran A, Mumtaz K, Husain S. Anti-Aspergillus Prophylaxis in Lung Transplantation: A Systematic Review and Meta-analysis. Curr Infect Dis Rep 2013; 15:514-25. [DOI: 10.1007/s11908-013-0380-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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145
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146
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Neoh C, Snell G, Levvey B, Kotsimbos T, Morrissey C, Slavin M, Stewart K, Kong D. Preemptive treatment with voriconazole in lung transplant recipients. Transpl Infect Dis 2013; 15:344-53. [DOI: 10.1111/tid.12071] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 09/08/2012] [Accepted: 11/11/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - G.I. Snell
- Lung Transplant Service; The Alfred Hospital; Monash University; Melbourne; Australia
| | - B. Levvey
- Lung Transplant Service; The Alfred Hospital; Monash University; Melbourne; Australia
| | - T. Kotsimbos
- Lung Transplant Service; The Alfred Hospital; Monash University; Melbourne; Australia
| | - C.O. Morrissey
- Infectious Diseases Unit; The Alfred Hospital; Monash University; Melbourne; Australia
| | | | - K. Stewart
- Centre for Medicine Use and Safety; Monash University; Melbourne; Australia
| | - D.C.M. Kong
- Centre for Medicine Use and Safety; Monash University; Melbourne; Australia
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147
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Singh N, Singh NM, Husain S. Aspergillosis in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:228-41. [PMID: 23465016 DOI: 10.1111/ajt.12115] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- N Singh
- VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA, USA.
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148
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Bronchiolitis obliterans syndrome, hypogammaglobulinemia, and infectious complications of lung transplantation. J Heart Lung Transplant 2013; 32:36-43. [DOI: 10.1016/j.healun.2012.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 09/17/2012] [Accepted: 10/17/2012] [Indexed: 11/18/2022] Open
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149
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Shields RK, Clancy CJ, Gillis LM, Kwak EJ, Silveira FP, Massih RCA, Eschenauer GA, Potoski BA, Nguyen MH. Epidemiology, clinical characteristics and outcomes of extensively drug-resistant Acinetobacter baumannii infections among solid organ transplant recipients. PLoS One 2012; 7:e52349. [PMID: 23285002 PMCID: PMC3527518 DOI: 10.1371/journal.pone.0052349] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 11/13/2012] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Extensively drug-resistant Acinetobacter baumannii (XDR-Ab) has emerged as a major nosocomial pathogen, but optimal treatment regimens are unknown. Although solid organ transplant (SOT) recipients are particularly susceptible to XDR-Ab infections, studies in this population are limited. Our objectives were to determine the epidemiology, clinical characteristics and outcomes of XDR-Ab infections among SOT patients. METHODS A retrospective study of SOT recipients at our center who were colonized or infected with XDR-Ab between November 2006 and December 2011 was conducted. Among infected patients, the primary outcome was survival at 28 days. Secondary outcomes included survival at 90 days and clinical success at 28 days, and XDR-Ab infection recurrence. RESULTS XDR-Ab was isolated from 69 SOT patients, of whom 41% (28) and 59% (41) were colonized and infected, respectively. Infections were significantly more common among cardiothoracic than abdominal transplant recipients (p=0.0004). Ninety-eight percent (40/41) of patients had respiratory tract infections, most commonly ventilator-associated pneumonia (VAP; 88% [36/41]). Survival rates at 28 and 90 days were 54% (22/41) and 46% (19/41), respectively. Treatment with a colistin-carbapenem regimen was an independent predictor of 28-day survival (p=0.01; odds ratio=7.88 [95% CI: 1.60-38.76]). Clinical success at 28 days was achieved in 49% (18/37) of patients who received antimicrobial therapy, but 44% (8/18) of successes were associated with infection recurrence within 3 months. Colistin resistance emerged in 18% (2/11) and 100% (3/3) of patients treated with colistin-carbapenem and colistin-tigecycline, respectively (p=0.03). CONCLUSIONS XDR-Ab causes VAP and other respiratory infections following SOT that are associated with significant recurrence and mortality rates. Cardiothoracic transplant recipients are at greatest risk. Results from this retrospective study suggest that colistin-carbapenem combinations may result in improved clinical responses and survival compared to other regimens and may also limit the emergence of colistin resistance.
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Affiliation(s)
- Ryan K. Shields
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Cornelius J. Clancy
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- VA Healthcare System Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Louise M. Gillis
- Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
- Department of Pharmacy & Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Eun J. Kwak
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Fernanda P. Silveira
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Rima C. Abdel Massih
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Gregory A. Eschenauer
- Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Brian A. Potoski
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
- Department of Pharmacy & Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - M. Hong Nguyen
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
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150
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Arslan D, Danziger-Isakov L. Respiratory viral infections in pediatric solid organ and hematopoietic stem cell transplantation. Curr Infect Dis Rep 2012; 14:658-67. [PMID: 22968439 PMCID: PMC7089512 DOI: 10.1007/s11908-012-0294-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Respiratory viruses are common in children, including pediatric recipients of both solid organ transplantation and hematopoietic stem cell transplantation. The prevalence and risk factors in each of these groups are reviewed. Furthermore, associated morbidity and mortality in pediatric transplant recipients with respiratory viral infections are addressed. The literature on specific prevention and treatment options for respiratory syncytial virus, adenovirus, influenza, and other respiratory viruses in pediatric solid organ and hematopoietic stem cell transplant recipients is reported.
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Affiliation(s)
- Defne Arslan
- Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA,
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