Understanding the concept of health care associated pneumonia (HCAP) in lung transplant recipients.
Chest. 2015 Mar 5;
Authors: Palacio F, Reyes LF, Levine DJ, Sanchez JF, Angel LF, Fernandez JF, Levine SM, Rello J, Abedi A, Restrepo MI
Background: Limited data are available regarding the etiological impact of healthcare associated pneumonia (HCAP) in lung transplant recipients. Therefore, our aim was to evaluate the microbiological differences between HCAP and hospital-acquired (HAP)/ventilator-associated pneumonia (VAP) in lung transplant recipients with radiographically confirmed diagnosis of pneumonia.
Methods: We performed a retrospective cohort study of lung transplant recipients with pneumonia at one transplant center over a 7-year period. Eligible patients included lung transplant recipients that developed a first episode of pneumonia after 48 hours following transplantation with radiographic confirmation. HCAP, HAP and VAP were classified according to the ATS/IDSA 2005 guidelines. Chi-square and Student's t-test were used to compare categorical and continuous variables, respectively.
Results: Sixty-eight lung transplant recipients developed at least 1 episode of pneumonia. HCAP (42[62%]) was most common followed by HAP/VAP (26[38%]) stratified in HAP (20[77%]) and VAP (6[23%]). Pseudomonas aeruginosa was the predominantly isolated organism (22[32%]), whereas invasive aspergillosis was uncommon (<10%). MDR pathogens were less frequently isolated in patients with HCAP compared to HAP/VAP (5% vs. 27% p=0.009). Opportunistic pathogens were less frequently identified in lung transplant recipients with HCAP compared to HAP/VAP (7% vs. 27%, p=0.02). Lung transplant recipients with HCAP had a similar mortality at 90-days (9[21 %] vs. 4[15 %] p =0.3) compared to HAP/VAP patients.
Conclusion: HCAP was the most frequent infection in lung transplant recipients. MDR pathogens and opportunistic pathogens were more frequently isolated in HAP/VAP. There were no differences in 30 and 90-day mortality between HCAP and HAP/VAP lung transplant recipients.
PMID: 25742187 [PubMed - as supplied by publisher]