Infection after lung transplantation.
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.
Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, PA 15261.
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D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D005544:Forecasting; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D017053:Infection Control / Q000379:methods; D007239:Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D016040:Lung Transplantation / Q000009:adverse effects*; D015995:Prevalence; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents