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Author Spotlight: Investigating the Key Factors of Obliterative Bronchiolitis After Lung Transplantation
Published on: November 10, 2023
Fungal Isolation in Respiratory Tract After Lung Transplantation: Epidemiology, Clinical Consequences, and Associated
E Atchade1, M Desmard2, E Kantor1
1Département d'Anesthésie Réanimation APHP, CHU Bichat-Claude Bernard, Paris, France.
Background:
Fungus-positive respiratory samples (FPRS) are common in the intensive Care unit (ICU) and are usually considered to correspond to colonization. The management of FPRS during the early postoperative course after lung transplantation (LT) remains unclear. The epidemiology, clinical consequences, and prognosis of FPRS were assessed in LT recipients.
Methods:
Over a 6-year period, we analyzed the postoperative ICU course of 176 LT recipients with a specific focus on microbiological results of routine respiratory samples and clinical course. The outcomes during the ICU stay at day 28 and at 1 year were compared in patients with or without FPRS. Results are expressed as median and interquartile range.
Results:
In the pretransplantation period, Candida spp were reported in 17% of patients. No routine post-LT antifungal prophylaxis was initiated. In the post-LT period, at least 1 FPRS was observed in 69% of patients (93% Candida spp, 7% Aspergillus spp). Double LT (odds ratio = 4.15, 95% confidence interval [1.67-11.80], P = .0007) was the only risk factor associated with Candida spp in respiratory samples. Antifungal therapy was administered in 58% of patients with post-LT Candida-positive samples. Candida spp in post-LT respiratory samples were not associated with increased ICU, 28-day, or 1-year mortality rates.
Conclusion:
A high prevalence of FPRS is reported after LT, mainly with Candida spp. The lack of association between post-LT FPRS and mortality and morbidity suggests avoiding antifungal therapy in the absence of clinical signs of invasive infection.
Insights
Fungus-positive respiratory samples (FPRS) are common after lung transplantation (LT) but typically represent colonization. Post-LT FPRS, mainly Candida, did not increase mortality, suggesting antifungal therapy should be reserved for invasive infections.
Area of Science:
- Medical Microbiology
- Pulmonology
- Critical Care Medicine
Background:
- Fungus-positive respiratory samples (FPRS) are frequently observed in intensive care units (ICUs), often indicating colonization rather than infection.
- The management and clinical significance of FPRS in the immediate postoperative period following lung transplantation (LT) are not well-defined.
- This study investigates the epidemiology, clinical impact, and prognosis of FPRS in lung transplant recipients.
Purpose of the Study:
- To assess the prevalence and characteristics of fungus-positive respiratory samples (FPRS) in lung transplant (LT) recipients post-surgery.
- To determine the clinical consequences and impact on mortality of FPRS in the early postoperative course and up to one year after LT.
- To provide evidence-based recommendations for the management of FPRS in LT patients.
Main Methods:
- A retrospective analysis of 176 lung transplant recipients over a 6-year period.
- Detailed review of microbiological results from routine respiratory samples and clinical data during the postoperative intensive care unit (ICU) stay.
- Comparison of outcomes (ICU stay, 28-day, and 1-year mortality) between patients with and without FPRS.
Main Results:
- FPRS were detected in 69% of patients post-LT, predominantly Candida spp. (93%).
- Double lung transplantation was identified as a significant risk factor for Candida spp. in respiratory samples (OR = 4.15).
- Despite 58% of patients with Candida-positive samples receiving antifungal therapy, FPRS were not associated with increased ICU, 28-day, or 1-year mortality.
Conclusions:
- Fungus-positive respiratory samples, primarily Candida, are highly prevalent after lung transplantation.
- The findings suggest that FPRS in LT recipients are generally associated with colonization and do not significantly increase mortality or morbidity.
- Antifungal therapy should be avoided in the absence of clear clinical signs of invasive fungal infection in post-LT patients.
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