sábado, 16 de junio de 2018

Morbidity and mortality related to pneumonia and TRACHEOBRONCHITIS in ICU after lung transplantation | BMC Pulmonary Medicine | Full Text

Morbidity and mortality related to pneumonia and TRACHEOBRONCHITIS in ICU after lung transplantation | BMC Pulmonary Medicine | Full Text

BMC Pulmonary Medicine

Morbidity and mortality related to pneumonia and TRACHEOBRONCHITIS in ICU after lung transplantation

  • Sebastien TanakaEmail authorView ORCID ID profile,
  • Claire Geneve,
  • Gianpiero Tebano,
  • Nathalie Grall,
  • Pascal Piednoir,
  • Régis Bronchard,
  • Mathieu Godement,
  • Enora Atchade,
  • Pascal Augustin,
  • Herve Mal,
  • Yves Castier,
  • Philippe Montravers and
  • Mathieu Desmard
Contributed equally
BMC Pulmonary MedicineBMC series – open, inclusive and trusted201818:43
Received: 30 September 2017
Accepted: 27 February 2018
Published: 5 March 2018

Abstract

Background

Bacterial respiratory infections (BRI) are major complications contributing to increased morbidity and mortality after lung transplantation (LT). This study analyzed epidemiology and outcome of 175 consecutive patients developing BRI in ICU after LT between 2006 and 2012.

Methods

Three situations were described: colonization determined in donors and recipients, pneumonia and tracheobronchitis during the first 28 postoperative days. Severity score, demographic, bacteriologic and outcome data were collected.

Results

26% of donors and 31% of recipients were colonized. 92% of recipients developed BRI, including at least one episode of pneumonia in 19% of recipients. Only 21% of recipients developed BRI with an organism cultured from the donor’s samples, while 40% of recipients developed BRI with their own bacteria cultured before LT. Purulent sputum appears to be an important factor to discriminate tracheobronchitis from pneumonia. When compared to patients with tracheobronchitis, those with pneumonia had longer durations of mechanical ventilation (13 [3–27] vs 3 [29], p = 0.0005) and ICU stay (24 [16–34] vs 14 [9-22], p = 0.002). Pneumonia was associated with higher 28-day (11 (32%) vs 9 (7%), p = 0.0004) and one-year mortality rates (21 (61%) vs 24 (19%), p ≤ 0.0001).

Conclusions

These data confirm the high frequency of BRI right from the early postoperative period and the poor prognosis of pneumonia after LT.

Keywords

Lung transplantationPneumoniaBronchitisMortalityICU

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