1
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Moneke I, Kalbhenn J. Successful Bridge to Lung Transplant in a Patient With Cystic Fibrosis Colonized With Pan-Resistant Burkholderia Multivorans. J Cardiothorac Vasc Anesth 2023; 37:2603-2606. [PMID: 37775342 DOI: 10.1053/j.jvca.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Isabelle Moneke
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Johannes Kalbhenn
- Department of Anesthesia and Critical Care Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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2
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Divithotawela C, Pham A, Bell PT, Ledger EL, Tan M, Yerkovich S, Grant M, Hopkins PM, Wells TJ, Chambers DC. Inferior outcomes in lung transplant recipients with serum Pseudomonas aeruginosa specific cloaking antibodies. J Heart Lung Transplant 2021; 40:951-959. [PMID: 34226118 DOI: 10.1016/j.healun.2021.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/21/2021] [Accepted: 05/24/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Chronic Lung Allograft Dysfunction (CLAD) limits long-term survival following lung transplantation. Colonization of the allograft by Pseudomonas aeruginosa is associated with an increased risk of CLAD and inferior overall survival. Recent experimental data suggests that 'cloaking' antibodies targeting the O-antigen of the P. aeruginosa lipopolysaccharide cell wall (cAbs) attenuate complement-mediated bacteriolysis in suppurative lung disease. METHODS In this retrospective cohort analysis of 123 lung transplant recipients, we evaluated the prevalence, risk factors and clinical impact of serum cAbs following transplantation. RESULTS cAbs were detected in the sera of 40.7% of lung transplant recipients. Cystic fibrosis and younger age were associated with increased risk of serum cAbs (CF diagnosis, OR 6.62, 95% CI 2.83-15.46, p < .001; age at transplant, OR 0.69, 95% CI 0.59-0.81, p < .001). Serum cAbs and CMV mismatch were both independently associated with increased risk of CLAD (cAb, HR 4.34, 95% CI 1.91-9.83, p < .001; CMV mismatch (D+/R-), HR 5.40, 95% CI 2.36-12.32, p < .001) and all-cause mortality (cAb, HR 2.75, 95% CI 1.27-5.95, p = .010, CMV mismatch, HR 3.53, 95% CI 1.62-7.70, p = .002) in multivariable regression analyses. CONCLUSIONS Taken together, these findings suggest a potential role for 'cloaking' antibodies targeting P. aeruginosa LPS O-antigen in the immunopathogenesis of CLAD.
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Affiliation(s)
| | - Amy Pham
- The University of Queensland, Diamantina Institute, The University of Queensland, Wooloongabba, Australia
| | - Peter T Bell
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Emma L Ledger
- The University of Queensland, Diamantina Institute, The University of Queensland, Wooloongabba, Australia
| | - Maxine Tan
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Australia
| | | | - Michelle Grant
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Australia
| | - Peter M Hopkins
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Timothy J Wells
- The University of Queensland, Diamantina Institute, The University of Queensland, Wooloongabba, Australia; Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, Australia
| | - Daniel C Chambers
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia.
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3
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Morrell ED, Lease ED. Host-Pathogen Interactions after Lung Transplant: Are Cystic Fibrosis Patients Unique? CELL REPORTS MEDICINE 2020; 1:100061. [PMID: 33205066 PMCID: PMC7659561 DOI: 10.1016/j.xcrm.2020.100061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The impact of Pseudomonas aeruginosa airway colonization on lung allografts is not entirely clear. In this issue of Cell Reports Medicine, Dugger et al.1 identify distinct clinical outcomes and lung allograft biology in recipients with and without cystic fibrosis.
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Affiliation(s)
- Eric D Morrell
- VA Puget Sound Heath Care System, Seattle, WA 98109, USA.,Harborview Medical Center, Seattle, WA 98109, USA.,University of Washington Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA 98195, USA
| | - Erika D Lease
- University of Washington Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA 98195, USA
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4
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Dugger DT, Fung M, Zlock L, Caldera S, Sharp L, Hays SR, Singer JP, Leard LE, Golden JA, Shah RJ, Kukreja J, Gordon E, Finkbeiner W, Kleinhenz ME, Langelier C, Greenland JR. Cystic Fibrosis Lung Transplant Recipients Have Suppressed Airway Interferon Responses during Pseudomonas Infection. CELL REPORTS MEDICINE 2020; 1. [PMID: 32754722 PMCID: PMC7402593 DOI: 10.1016/j.xcrm.2020.100055] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Lung transplantation can be lifesaving in end-stage cystic fibrosis (CF), but long-term survival is limited by chronic lung allograft dysfunction (CLAD). Persistent upper airway Pseudomonas aeruginosa (PsA) colonization can seed the allograft. While de novo PsA infection is associated with CLAD in non-CF recipients, this association is less clear for CF recipients experiencing PsA recolonization. Here, we evaluate host and pathogen contributions to this phenomenon. In the context of PsA infection, brushings from the airways of CF recipients demonstrate type 1 interferon gene suppression. Airway epithelial cell (AEC) cultures demonstrate similar findings in the absence of pathogens or immune cells, contrasting with the pre-transplant CF AEC phenotype. Type 1 interferon promoters are relatively hypermethylated in CF AECs. CF subjects in this cohort have more mucoid PsA, while non-CF PsA subjects have decreased microbiome α diversity. Peri-transplant protocols may benefit from consideration of this host and microbiome equilibrium. Lung allograft Pseudomonas infection outcomes are better for recipients with CF In CF, infected allograft airway cells demonstrate suppression of interferon genes Differential DNA methylation may contribute to this distinct epithelial phenotype Increased α diversity and mucoid forms characterize CF Pseudomonas infection
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Affiliation(s)
- Daniel T Dugger
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Monica Fung
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Lorna Zlock
- Department of Pathology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Saharai Caldera
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Louis Sharp
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Steven R Hays
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Jonathan P Singer
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Lorriana E Leard
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Jefferey A Golden
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Rupal J Shah
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Jasleen Kukreja
- Department of Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Erin Gordon
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Walter Finkbeiner
- Department of Pathology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Mary Ellen Kleinhenz
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Chaz Langelier
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.,Chan Zuckerberg Biohub, San Francisco, CA 94143, USA
| | - John R Greenland
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.,Medical Service, Veterans Affairs Health Care System, San Francisco, CA 94121, USA.,Lead Contact
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5
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Acosta N, Waddell B, Heirali A, Somayaji R, Surette MG, Workentine ML, Rabin HR, Parkins MD. Cystic Fibrosis Patients Infected With Epidemic Pseudomonas aeruginosa Strains Have Unique Microbial Communities. Front Cell Infect Microbiol 2020; 10:173. [PMID: 32426295 PMCID: PMC7212370 DOI: 10.3389/fcimb.2020.00173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/01/2020] [Indexed: 11/13/2022] Open
Abstract
Pseudomonas aeruginosa is the archetypal cystic fibrosis (CF) pathogen. However, the clinical course experienced by infected individuals varies markedly. Understanding these differences is imperative if further improvements in outcomes are to be achieved. Multiple studies have found that patients infected with epidemic P. aeruginosa (ePA) strains may have a worse clinical prognosis than those infected with unique, non-clonal strains. Additionally, the traditionally uncultured CF lung bacterial community (i.e., CF microbiome) may further influence the outcome. We sought to identify if these two important variables, not identified through routine culture, associate and together may contribute to disease pathogenesis. Patients were classified as being infected with Prairie Epidemic ePA (PES) or a non-clonal strain, unique PA strains (uPA), through a retrospective assessment of a comprehensive strain biobank using a combination of PFGE and PES-specific PCR. Patients were matched to age, sex, time-period controls and sputum samples from equivalent time periods were identified from a sputum biobank. Bacterial 16S rRNA gene profiling and Pseudomonas qPCR was used to characterize the respiratory microbiome. We identified 31 patients infected with PES and matched them with uPA controls. Patients infected with PES at baseline have lower microbial diversity (P = 0.02) and higher P. aeruginosa relative abundance (P < 0.005). Microbial community structure was found to cluster by PA strain type, although it was not the main determinant of community structure as additional factors were also found to be drivers of CF community structure. Communities from PES infected individuals were enriched with Pseudomonas, Streptococcus and Prevotella OTUs. The disproportionate disease experienced by ePA infected CF patients may be mediated through a combination of pathogen-pathogen factors as opposed to strictly enhanced virulence of infecting P. aeruginosa strains.
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Affiliation(s)
- Nicole Acosta
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada
| | - Barbara Waddell
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada
| | - Alya Heirali
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada
| | - Ranjani Somayaji
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael G Surette
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada.,Departments of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Harvey R Rabin
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael D Parkins
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
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6
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Screening of donors and recipients for infections prior to solid organ transplantation. Curr Opin Organ Transplant 2020; 24:456-464. [PMID: 31290846 DOI: 10.1097/mot.0000000000000671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review is a brief overview of current guidelines on screening donors and candidates for bacterial, fungal, parasitic and viral infections prior to solid organ transplantation. The pretransplant period is an important time to evaluate infection exposure risk based on social history as well as to offer vaccinations. RECENT FINDINGS One of the major changes in the past few years has been increased utilization of increased Public Health Service risk, HIV positive, and hepatitis C-positive donors. There has also been increased attention to donor and recipient risks for geographically associated infections, such as endemic fungal infections and flaviviruses. SUMMARY Screening for donors and candidates prior to organ transplantation can identify and address infection risks. Diagnosing infections in a timely manner can help guide treatment and additional testing. Use of necessary prophylactic treatment in organ recipients can prevent reactivation of latent infections and improve posttransplant outcomes.
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7
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Kawashima M, Juvet SC. The role of innate immunity in the long-term outcome of lung transplantation. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:412. [PMID: 32355856 PMCID: PMC7186608 DOI: 10.21037/atm.2020.03.20] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Long-term survival after lung transplantation remains suboptimal due to chronic lung allograft dysfunction (CLAD), a progressive scarring process affecting the graft. Although anti-donor alloimmunity is central to the pathogenesis of CLAD, its underlying mechanisms are not fully elucidated and it is neither preventable nor treatable using currently available immunosuppression. Recent evidence has shown that innate immune stimuli are fundamental to the development of CLAD. Here, we examine long-standing assumptions and new concepts linking innate immune activation to late lung allograft fibrosis.
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Affiliation(s)
- Mitsuaki Kawashima
- Latner Thoracic Research Laboratories, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Stephen C Juvet
- Latner Thoracic Research Laboratories, University Health Network, University of Toronto, Toronto, Ontario, Canada
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8
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Koutsokera A, Varughese RA, Sykes J, Orchanian-Cheff A, Shah PS, Chaparro C, Tullis E, Singer LG, Stephenson AL. Pre-transplant factors associated with mortality after lung transplantation in cystic fibrosis: A systematic review and meta-analysis. J Cyst Fibros 2019; 18:407-415. [DOI: 10.1016/j.jcf.2018.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 01/17/2023]
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9
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Zhao J, Cheng W, He X, Liu Y. The co-colonization prevalence of Pseudomonas aeruginosa and Aspergillus fumigatus in cystic fibrosis: A systematic review and meta-analysis. Microb Pathog 2018; 125:122-128. [PMID: 30217514 DOI: 10.1016/j.micpath.2018.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/26/2018] [Accepted: 09/05/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE The co-colonization prevalence of P. aeruginosa and A. fumigatus in cystic fibrosis (CF) has been inconsistently reported. The purpose of this systematic review and meta-analysis was to estimate the overall co-colonization prevalence of P. aeruginosa and A. fumigatus in CF. METHODS The Embase, PubMed and Web of Science databases were systematically searched for studies reporting the co-colonization prevalence of P. aeruginosa and A. fumigatus in CF. The co-colonization prevalence of two pathogenic microorganisms in the individual studies was assessed by calculating the proportion and 95% confidence interval (CI). The random effects model was used to calculate the pooled prevalence. The I2 test was used to assess statistical heterogeneity. The funnel plot and two statistical methods were used to assess publication bias. RESULTS Twenty-three eligible studies were included in this analysis. The pooled co-colonization prevalence of P. aeruginosa and A. fumigatus in CF patients was 15.8% (95% CI: 9.9-21.8). The co-colonization prevalence of P. aeruginosa and A. fumigatus chronic colonization was lower than that of intermittent colonization, higher in sputum cultures than in bronchoalveolar lavage (BAL) cultures, and lower in children than in adults. There was a statistically significant difference in co-colonization prevalence among studies from different decades, but the prevalence was similar in different geographical regions and with different study types. CONCLUSIONS The co-colonization prevalence of P. aeruginosa and A. fumigatus in the lower respiratory tract of CF patients was high. The anti-infective treatment in exacerbation of CF should be considered to cover the two pathogenic microorganisms simultaneously. Large-scale research is still needed to obtain more accurate co-colonization data.
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Affiliation(s)
- Jingming Zhao
- Department of Respiratory Medicine, The Affiliated Hospital of Qingdao University, 16#, Jiangsu Road, Qingdao, 266003, PR China.
| | - Wei Cheng
- Department of Respiratory Medicine, The Affiliated Hospital of Qingdao University, 16#, Jiangsu Road, Qingdao, 266003, PR China
| | - Xigang He
- Department of Respiratory Medicine, People's Hospital of Rizhao Lanshan, 566#, Lanshan Xi Road, Lanshan District, Rizhao, 276807, PR China
| | - Yanli Liu
- Department of Respiratory Medicine, The Affiliated Hospital of Qingdao University, 16#, Jiangsu Road, Qingdao, 266003, PR China
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10
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Epidemiology, Biology, and Impact of Clonal Pseudomonas aeruginosa Infections in Cystic Fibrosis. Clin Microbiol Rev 2018; 31:31/4/e00019-18. [PMID: 30158299 DOI: 10.1128/cmr.00019-18] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Chronic lower airway infection with Pseudomonas aeruginosa is a major contributor to morbidity and mortality in individuals suffering from the genetic disease cystic fibrosis (CF). Whereas it was long presumed that each patient independently acquired unique strains of P. aeruginosa present in their living environment, multiple studies have since demonstrated that shared strains of P. aeruginosa exist among individuals with CF. Many of these shared strains, often referred to as clonal or epidemic strains, can be transmitted from one CF individual to another, potentially reaching epidemic status. Numerous epidemic P. aeruginosa strains have been described from different parts of the world and are often associated with an antibiotic-resistant phenotype. Importantly, infection with these strains often portends a worse prognosis than for infection with nonclonal strains, including an increased pulmonary exacerbation rate, exaggerated lung function decline, and progression to end-stage lung disease. This review describes the global epidemiology of clonal P. aeruginosa strains in CF and summarizes the current literature regarding the underlying biology and clinical impact of globally important CF clones. Mechanisms associated with patient-to-patient transmission are discussed, and best-evidence practices to prevent infections are highlighted. Preventing new infections with epidemic P. aeruginosa strains is of paramount importance in mitigating CF disease progression.
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11
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Orfanos S, Gomez C, Baron S, Akkisetty R, Dufeu N, Coltey B, Thomas PA, Rolain JM, Reynaud-Gaubert M. Impact of gram negative bacteria airway recolonization on the occurrence of chronic lung allograft dysfunction after lung transplantation in a population of cystic fibrosis patients. BMC Microbiol 2018; 18:88. [PMID: 30126365 PMCID: PMC6102836 DOI: 10.1186/s12866-018-1231-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 08/10/2018] [Indexed: 12/15/2022] Open
Abstract
Background Chronic Lung Allograft Dysfunction (CLAD) is the main cause of morbidity and mortality after the first year following lung transplantation (LTx). Risk factors of CLAD have been extensively studied, but the association between gram-negative bacteria (GNB) bronchial colonization and the development of CLAD is controversial. The purpose of our study was to investigate the association between post-transplant recolonization with the same species or de-novo colonization with a new GNB species and CLAD. The same analysis was performed on a sub-group of patients at the strain level using Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry technique. Results Forty adult cystic fibrosis (CF) patients who underwent a first bilateral LTx in the University Hospital of Marseille, between January 2010 and December 2014, were included in the study. Patients with GNB de-novo colonization had a higher risk of developing CLAD (OR = 6.72, p = 0.04) and a lower rate of CLAD-free survival (p = 0.005) compared to patients with GNB recolonization. No conclusion could be drawn from the subgroup MALDI-TOF MS analysis at the strain level. Conclusion Post-LTx GNB airway recolonization seems to be a protective factor against CLAD, whereas de-novo colonization with a new species of GNB seems to be a risk factor for CLAD. Electronic supplementary material The online version of this article (10.1186/s12866-018-1231-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Orfanos
- Aix-Marseille University, Faculté de médecine, Marseille, France.
| | - Carine Gomez
- Aix-Marseille University, Faculté de médecine, Marseille, France.,Department of Respiratory Diseases, Lung Transplant Team, University Hospital of Marseille, Marseille, France
| | - Sophie Baron
- Aix-Marseille University, Faculté de médecine, Marseille, France.,URMITE CNRS IRD UMR 6236, IHU Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - Ritesh Akkisetty
- Department of Biology, Drexel University College of Art and Sciences, Philadelphia, USA
| | - Nadine Dufeu
- Department of Respiratory Diseases, Lung Transplant Team, University Hospital of Marseille, Marseille, France
| | - Bérengère Coltey
- Department of Respiratory Diseases, Lung Transplant Team, University Hospital of Marseille, Marseille, France
| | - Pascal Alexandre Thomas
- Aix-Marseille University, Faculté de médecine, Marseille, France.,Department of Thoracic Surgery, Lung Transplant Team APHM, University Hospital of Marseille, Marseille, France
| | - Jean Marc Rolain
- Aix-Marseille University, Faculté de médecine, Marseille, France.,URMITE CNRS IRD UMR 6236, IHU Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - Martine Reynaud-Gaubert
- Aix-Marseille University, Faculté de médecine, Marseille, France.,Department of Respiratory Diseases, Lung Transplant Team, University Hospital of Marseille, Marseille, France
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12
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Lee AC, Jones AL. Multi-resistant Pseudomonas aeruginosa ST235 in cystic fibrosis. Paediatr Respir Rev 2018; 27:18-20. [PMID: 29914746 DOI: 10.1016/j.prrv.2018.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/10/2018] [Indexed: 11/17/2022]
Abstract
Chronic Pseudomonas aeruginosa infection is associated with a decline in lung function and overall poorer prognosis in the cystic fibrosis population. Molecular typing of P. aeruginosa has identified multiple clonal strains with increased virulence and transmissibility. P. aeruginosa ST235 is an emerging clonal strain with multi-drug resistance and is associated with more virulent infections. Novel cephalosporins, which have recently been introduced to clinical practice, may have higher efficacy against multi-drug resistant bacteria.
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Affiliation(s)
- Annabelle C Lee
- Department of Cystic Fibrosis, Royal Brompton & Harefield Foundation NHS Trust, United Kingdom.
| | - Andrew L Jones
- Department of Cystic Fibrosis, Royal Brompton & Harefield Foundation NHS Trust, United Kingdom
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13
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Schiavon M, Faggi G, Di Gregorio G, Calabrese F, Lunardi F, Marulli G, Feltracco P, Loy M, Damin M, Cozzi E, Gregori D, Calabrese F, Rea F. Single-center experience in urgent lung transplantation program in a country with a shortage of donors: Does the end justify the means? Clin Transplant 2017; 31. [PMID: 28972662 DOI: 10.1111/ctr.13129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 11/28/2022]
Abstract
In rapidly deteriorating patients awaiting lung transplantation (LT), supportive strategies are only temporary and urgent lung transplant (ULT) remains the last option. The few publications on this topic report conflicting results. According to the Italian national program, patients on mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO) may be included in urgent list. We reviewed our experience from January 2012 to December 2014 with ULT and elective lung transplantation (ELT), focusing on outcomes. In the study period, 16 patients received ULT, while 51 received ELT. Among ULT, 1 patient (5.8%) died in waiting list (WL) while 16 patients underwent LT with a median WL time of 6 days. ELT WL mortality was 13.5%, and median WL time 368 days. In-hospital mortality was lower in ELT group (5.8% vs 37.5%, P < .01), while the other postoperative outcomes were not significantly different. For ULT patients, the highest impact risk factors for in-hospital mortality were pretransplant plasma transfusion, recipient Pseudomonas aeruginosa colonization, and high level of reactive C-protein and lactic acid. A ULT program with an accurate recipient selection allows earlier transplantation, reducing WL mortality, with acceptable outcomes, although with a higher in-hospital mortality. Larger studies are needed to validate our results.
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Affiliation(s)
- Marco Schiavon
- Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Giulio Faggi
- Unit of Anaesthesia and Intensive Care, Padua Hospital, Padova, Italy
| | - Guido Di Gregorio
- Department of Anaesthesia and Intensive Care, University of Padova, Padova, Italy
| | - Francesca Calabrese
- Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Francesca Lunardi
- Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Giuseppe Marulli
- Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Paolo Feltracco
- Department of Anaesthesia and Intensive Care, University of Padova, Padova, Italy
| | - Monica Loy
- Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Marco Damin
- Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Emanuele Cozzi
- Transplant Immunology Unit, University of Padua, Padova, Italy
| | - Dario Gregori
- Department of Statistics, University of Padova, Padova, Italy
| | - Fiorella Calabrese
- Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Federico Rea
- Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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