Universal Multiplex Panel Testing of Donor Lungs as a Strategy to Optimize Antibiotic Prophylaxis Against...

Area of Science:

• Infectious Disease Epidemiology
• Transplant Surgery
• Microbiology Diagnostics

Background:

• Twenty percent of lung donors harbor carbapenem-resistant (CR) gram-negative bacteria (GNB), posing a significant risk in lung transplantation.
• Acinetobacter baumannii is the most frequently identified CR-GNB in this donor population.
• Current diagnostic methods for CR-GNB can delay critical perioperative antibiotic decisions.

Purpose of the Study:

• To evaluate the implementation and impact of universal multiplex panel testing for CR-GNB in lung transplant donors.
• To assess the efficiency of rapid CR-GNB detection in optimizing perioperative antibiotic prophylaxis.
• To analyze the clinical utility of multiplex panel testing in a lung transplant program.

Main Methods:

• Retrospective single-center cohort study involving 53 adult lung transplant recipients.
• Implementation of universal multiplex panel testing for CR-GNB in lung donors starting June 2022.
• Analysis of bacterial identification, antibiotic administration, and clinical outcomes based on testing results.

Main Results:

• The multiplex panel identified common pathogens including Staphylococcus aureus, Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa.
• High negative predictive values were observed for the panel in detecting CR A. baumannii (94%), CR K. pneumoniae (100%), CR P. aeruginosa (100%), and MRSA (98%).
• Targeted antibiotic prophylaxis, including tigecycline, colistin, and novel beta-lactams, was administered based on panel or culture results in a significant proportion of patients.

Conclusions:

• The multiplex panel offers rapid detection of donor CR-GNB with high accuracy, facilitating timely clinical decisions.
• Implementation of this testing strategy led to reduced broad-spectrum antibiotic prescriptions.
• The approach maintained adequate post-transplant outcomes, suggesting its clinical benefit; further prospective studies are warranted.