Outcomes of a Routine Screening Protocol to Prevent Metamycoplasma and Ureaplasma Infection in Lung Transplant...

Area of Science:

• Transplantation Medicine
• Infectious Diseases
• Critical Care Medicine

Background:

• Metamycoplasma hominis and Ureaplasma species (Mollicutes) can cause significant infections early after lung transplantation (LT).
• Mollicute infections are linked to hyperammonemia syndrome (HS), a life-threatening complication characterized by cerebral edema.
• A need exists to evaluate strategies for early detection and preemptive treatment of Mollicutes post-LT.

Purpose of the Study:

• To assess the impact of a screening protocol for Mollicutes and ammonia levels in early post-lung transplantation.
• To compare the incidence of clinically significant Mollicute infections (csMI) and HS before and after protocol implementation.
• To identify risk factors associated with Mollicute detection post-LT.

Main Methods:

• Retrospective review of lung transplant recipients before and after implementing a screening protocol.
• Protocol included PCR testing for Mollicutes on bronchoalveolar lavage within 24 hours post-LT and serum ammonia monitoring every 48 hours.
• Antibiotic treatment was initiated for elevated ammonia (>60 µmol/L) or positive Mollicute PCR.

Main Results:

• Mollicutes were detected in 19.2% of screened patients; donor age ≤ 40 years was associated with positive PCR results.
• No significant differences were observed in 6-month mortality, 3-month rejection rates, or ICU length of stay between PCR-positive and PCR-negative groups.
• The protocol group had one case (0.8%) of csMI with no HS, while the pre-protocol group had 1.09% incidence of csMI or HS, including two deaths from HS.

Conclusions:

• Early post-LT Mollicute detection via PCR is inversely associated with donor age.
• Preemptive treatment for Mollicutes and elevated ammonia in the early post-transplant period may effectively prevent severe complications.
• The screening protocol shows promise in reducing the incidence of HS and csMI in lung transplant recipients.