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

Sebastien TanakaEmail author View 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

https://doi.org/10.1186/s12890-018-0605-9

Received: 30 September 2017

Accepted: 27 February 2018

Published: 5 March 2018

Open Peer Review reports

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).