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Infection after lung transplantation
1Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, PA 15261.
Abstract:
Infections have been and still are the major cause of morbidity and mortality after lung transplantation. Nevertheless, the negative impact of infection on outcome has lessened considerably over the last decade because of lessons learned in the prevention, identification, and treatment of infection. Antibiotics tailored to the results of cultures and stains of respiratory-tract secretions obtained from both the donor and recipient have markedly decreased the prevalence of bacterial pneumonia early after lung transplantation. Ganciclovir treatment has reduced the mortality of cytomegalovirus (CMV) disease from 27% to 1%. Ganciclovir as prophylaxis has modestly reduced the prevalence of CMV illness from 80% to 60%. Pneumocystis infection has been nearly eliminated with low-dose trimethropin/sulfamethoxazole prophylaxis. Treating all Candida/Aspergillus isolates from respiratory-tract secretions with fluconazole or itraconazole has reduced the prevalence of fungus infections from 14% to 5%. Challenges still remain. The ideal regimen to prevent CMV illness is yet to be determined, and treating all fungal isolates from the allograft is not cost effective. Recurrent airway infection and late bacterial pneumonia caused by Pseudomonas species when obliterative bronchiolitis is present remain a major cause of concern. Surely the next decade will provide new insights into these problems.
Insights
Lung transplant recipients face fewer infections due to improved prevention and treatment strategies. Advances in antibiotics and antivirals like ganciclovir have significantly reduced early bacterial pneumonia and cytomegalovirus (CMV) disease mortality.
Area of Science:
- Medicine
- Transplantation Surgery
- Infectious Diseases
Background:
- Infections remain a primary cause of morbidity and mortality following lung transplantation.
- Significant progress has been made in mitigating the impact of infections over the past decade.
Purpose of the Study:
- To review the advancements in the prevention, identification, and treatment of infections after lung transplantation.
- To highlight the reduced impact of infections on patient outcomes and identify remaining challenges.
Main Methods:
- Review of clinical practices and outcomes related to infection management in lung transplant recipients.
- Analysis of the efficacy of antimicrobial and antifungal prophylaxis and treatment regimens.
Main Results:
- Tailored antibiotic therapy has decreased early bacterial pneumonia.
- Ganciclovir has drastically reduced cytomegalovirus (CMV) disease mortality and illness prevalence.
- Pneumocystis pneumonia has been nearly eliminated with trimethoprim/sulfamethoxazole prophylaxis.
- Antifungal treatment with fluconazole or itraconazole reduced fungal infections from 14% to 5%.
Conclusions:
- While significant strides have been made, challenges persist, including optimizing CMV prophylaxis and cost-effective fungal infection management.
- Recurrent airway infections and late bacterial pneumonia, particularly Pseudomonas, remain critical concerns in lung transplant recipients.