Donor respiratory multidrug-resistant bacteria and lung transplantation outcomes
Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved..
RATIONALE: Respiratory culture screening is mandatory for all potential lung transplant donors. There is limited evidence on the significance of donor multidrug-resistant (MDR) bacteria on transplant outcomes. Establishing the safety of allografts colonized with MDR bacteria has implications for widening an already limited donor pool.
OBJECTIVES: We aimed to describe the prevalence of respiratory MDR bacteria among our donor population and to test for associations with posttransplant outcomes.
METHODS: This retrospective observational study included all adult patients who underwent lung-only transplantation for the first time at King Faisal Specialist Hospital & Research Centre in Riyadh from January 2015 through May 2022. The study evaluated donor bronchoalveolar lavage and bronchial swab cultures.
MAIN RESULTS: Sixty-seven of 181 donors (37%) had respiratory MDR bacteria, most commonly MDR Acinetobacter baumannii (n = 24), methicillin-resistant Staphylococcus aureus (n = 18), MDR Klebsiella pneumoniae (n = 8), MDR Pseudomonas aeruginosa (n = 7), and Stenotrophomonas maltophilia (n = 6). Donor respiratory MDR bacteria were not significantly associated with allograft survival or chronic lung allograft dysfunction (CLAD) in adjusted hazard models. Sensitivity analyses revealed an increased risk for 90-day mortality among recipients of allografts with MDR Klebsiella pneumoniae (n = 6 with strains resistant to a carbapenem and n = 2 resistant to a third-generation cephalosporin only) compared to those receiving culture-negative allografts (25.0% versus 11.1%, p = 0.04). MDR Klebsiella pneumoniae (aHR 3.31, 95%CI 0.95-11.56) and Stenotrophomonas maltophilia (aHR 5.35, 95%CI 1.26-22.77) were associated with an increased risk for CLAD compared to negative cultures.
CONCLUSION: Our data suggest the potential safety of using lung allografts with MDR bacteria in the setting of appropriate prophylaxis; however, caution should be exercised in the case of MDR Klebsiella pneumoniae.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:88 |
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| Enthalten in: |
The Journal of infection - 88(2024), 2 vom: 15. Feb., Seite 139-148 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Abdulqawi, Rayid [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 15.02.2024 Date Revised 15.02.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jinf.2023.12.013 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM367283018 |
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| 100 | 1 | |a Abdulqawi, Rayid |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Donor respiratory multidrug-resistant bacteria and lung transplantation outcomes |
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| 500 | |a Date Completed 15.02.2024 | ||
| 500 | |a Date Revised 15.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved. | ||
| 520 | |a RATIONALE: Respiratory culture screening is mandatory for all potential lung transplant donors. There is limited evidence on the significance of donor multidrug-resistant (MDR) bacteria on transplant outcomes. Establishing the safety of allografts colonized with MDR bacteria has implications for widening an already limited donor pool | ||
| 520 | |a OBJECTIVES: We aimed to describe the prevalence of respiratory MDR bacteria among our donor population and to test for associations with posttransplant outcomes | ||
| 520 | |a METHODS: This retrospective observational study included all adult patients who underwent lung-only transplantation for the first time at King Faisal Specialist Hospital & Research Centre in Riyadh from January 2015 through May 2022. The study evaluated donor bronchoalveolar lavage and bronchial swab cultures | ||
| 520 | |a MAIN RESULTS: Sixty-seven of 181 donors (37%) had respiratory MDR bacteria, most commonly MDR Acinetobacter baumannii (n = 24), methicillin-resistant Staphylococcus aureus (n = 18), MDR Klebsiella pneumoniae (n = 8), MDR Pseudomonas aeruginosa (n = 7), and Stenotrophomonas maltophilia (n = 6). Donor respiratory MDR bacteria were not significantly associated with allograft survival or chronic lung allograft dysfunction (CLAD) in adjusted hazard models. Sensitivity analyses revealed an increased risk for 90-day mortality among recipients of allografts with MDR Klebsiella pneumoniae (n = 6 with strains resistant to a carbapenem and n = 2 resistant to a third-generation cephalosporin only) compared to those receiving culture-negative allografts (25.0% versus 11.1%, p = 0.04). MDR Klebsiella pneumoniae (aHR 3.31, 95%CI 0.95-11.56) and Stenotrophomonas maltophilia (aHR 5.35, 95%CI 1.26-22.77) were associated with an increased risk for CLAD compared to negative cultures | ||
| 520 | |a CONCLUSION: Our data suggest the potential safety of using lung allografts with MDR bacteria in the setting of appropriate prophylaxis; however, caution should be exercised in the case of MDR Klebsiella pneumoniae | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acinetobacter baumannii | |
| 650 | 4 | |a Chronic lung allograft dysfunction | |
| 650 | 4 | |a Klebsiella pneumoniae | |
| 650 | 4 | |a Pseudomonas aeruginosa | |
| 650 | 4 | |a Staphylococcus aureus | |
| 650 | 4 | |a Stenotrophomonas maltophilia | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 700 | 1 | |a Saleh, Rana Ahmed |e verfasserin |4 aut | |
| 700 | 1 | |a Alameer, Reem Mahmoud |e verfasserin |4 aut | |
| 700 | 1 | |a Aldakhil, Haifa |e verfasserin |4 aut | |
| 700 | 1 | |a AlKattan, Khaled Manae |e verfasserin |4 aut | |
| 700 | 1 | |a Almaghrabi, Reem Saad |e verfasserin |4 aut | |
| 700 | 1 | |a Althawadi, Sahar |e verfasserin |4 aut | |
| 700 | 1 | |a Hashim, Mahmoud |e verfasserin |4 aut | |
| 700 | 1 | |a Saleh, Waleed |e verfasserin |4 aut | |
| 700 | 1 | |a Yamani, Amani Hassan |e verfasserin |4 aut | |
| 700 | 1 | |a Al-Mutairy, Eid Abdullah |e verfasserin |4 aut | |
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