Background

In recent decades, the incidence of multidrug-resistant (MDR) and extended-spectrum β-lactamase (ESBL) gram-negative (GN) bacteria has increased progressively among lung transplantation (LT) recipients. A prompt diagnosis, prevention, and management of these pathogens remain the cornerstone for successful organ transplantation.

Research Question

What are the incidence of MDR and ESBL GN bacteria within the first 30 days after LT and related risk of in-hospital mortality? What are the potential clinical predictors of isolation of MDR and ESBL GN bacteria?

Study Design and Methods

All consecutive LT recipients admitted to the ICU of the University Hospital of Padua (February 2016-December 2021) were screened retrospectively. Only adult patients undergoing the first bilateral LT and not requiring invasive mechanical ventilation, extracorporeal membrane oxygenation, or both before surgery were included. MDR and ESBL GN bacteria were identified using in vitro susceptibility tests and were isolated from the respiratory tract, blood, urine, rectal swab, or surgical wound or drainage according to a routine protocol.

Results

One hundred fifty-three LT recipients were screened, and 132 were considered for analysis. Median age was 52 years (interquartile range, 41-60 years) and 46 patients (35%) were women. MDR and ESBL GN bacteria were identified in 45 patients (34%), and 60% of patients demonstrated clinically relevant infection. Pseudomonas aeruginosa (n = 22 [49%]) and Klebsiella pneumoniae (n = 17 [38%]) were frequently isolated after LT from the respiratory tract (n = 21 [47%]) and multiple sites (n = 18 [40%]). Previous recipient-related colonization (hazard ratio [HR], 2.48 [95% CI, 1.04-5.90]; P = .04) and empirical exposure to broad-spectrum antibiotics (HR, 6.94 [95% CI, 2.93-16.46]; P < .01) were independent predictors of isolation of MDR and ESBL GN bacteria. In-hospital mortality of the MDR and ESBL group was 27% (HR, 6.38 [95% CI, 1.98-20.63]; P < .01).

Interpretation

The incidence of MDR and ESBL GN bacteria after LT was 34%, and in-hospital mortality was six times greater. Previous recipient-related colonization and empirical exposure to broad-spectrum antibiotics were clinical predictors of isolation of MDR and ESBL GN bacteria.

中文翻译：

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双侧肺移植受者的多重耐药和超广谱 β-内酰胺酶革兰氏阴性菌

背景

近几十年来，多药耐药 (MDR) 和超广谱 β-内酰胺酶 (ESBL) 革兰氏阴性 (GN) 细菌的发生率在肺移植 (LT) 受者中逐渐增加。及时诊断、预防和管理这些病原体仍然是器官移植成功的基石。

研究问题

LT 后头 30 天内 MDR 和 ESBL GN 细菌的发生率以及相关的院内死亡风险是多少？MDR 和 ESBL GN 细菌分离的潜在临床预测因子是什么？

研究设计和方法

对帕多瓦大学医院重症监护室（2016 年 2 月至 2021 年 12 月）收治的所有连续 LT 接受者进行了回顾性筛查。仅包括接受第一次双侧 LT 且术前不需要有创机械通气、体外膜氧合或两者的成年患者。MDR 和 ESBL GN 细菌是使用体外药敏试验鉴定的，并根据常规方案从呼吸道、血液、尿液、直肠拭子或手术伤口或引流液中分离出来。

结果

筛选了 153 名 LT 接受者，并考虑对 132 名进行分析。中位年龄为 52 岁（四分位数范围，41-60 岁），46 名患者 (35%) 为女性。在 45 名患者 (34%) 中鉴定出 MDR 和 ESBL GN 细菌，60% 的患者表现出临床相关感染。LT 后经常从呼吸道 (n = 21 [47%]) 和多个部位 (n = 18 [40] 分离出铜绿假单胞菌(n = 22 [49%]) 和肺炎克雷伯菌(n = 17 [38%]) %]). 既往接受者相关定植（风险比 [HR]，2.48 [95% CI，1.04-5.90]；P  = .04）和经验性广谱抗生素暴露（HR，6.94 [95% CI，2.93-16.46]；P < .01) 是 MDR 和 ESBL GN 细菌分离的独立预测因子。MDR 和 ESBL 组的院内死亡率为 27%（HR，6.38 [95% CI，1.98-20.63]；P  < .01）。

解释

LT 后 MDR 和 ESBL GN 细菌的发生率为 34%，住院死亡率高出六倍。既往接受者相关定植和经验性广谱抗生素暴露是 MDR 和 ESBL GN 细菌分离的临床预测因子。