Mycobacterium abscessus infections in lung transplant recipients: the international experience.
BACKGROUND
The clinical significance of Mycobacterium abscessus infection in the lung transplant population is not well understood.


METHODS
An international survey was performed to determine the incidence and clinical outcomes of M abscessus infections before and after lung transplantation.


RESULTS
Thirty-one (50%) of the 62 transplant centers affiliated with the International Society of Heart and Lung Transplantation responded to the survey. Of 5,200 transplants performed, 17 patients (0.33%) (M/F, 12:5) were identified with M abscessus after transplantation. Two patients had respiratory colonization before lung transplantation. Post-transplantation M abscessus infections occurred in the pulmonary allograft in 12, in skin/soft tissue in 3, or both in 2. Median time to diagnosis after transplantation was 18.5 months (range, 1-111 months). Therapies included multiple antibiotics in 16, surgical débridement in 2, interferon-gamma in 1, or no therapy owing to presumed colonization in 1. Eleven (73%) of 16 treated patients had a radiologic or microbiologic response to treatment. Concurrent infections were common, with Aspergillus (n = 8) and Pseudomonas aeruginosa (n = 5) most frequently seen. Death in 2 patients was attributed to M abscessus. Ten of 17 patients are alive and considered cured.


CONCLUSIONS
M abscessus infection in the lung transplant recipient is uncommon and challenging; however, successful treatment can occur. Prolonged combination anti-microbial therapy is required for pulmonary involvement, and surgical débridement is recommended for cutaneous lesions. Concurrent infections are common and may contribute to mortality in this immunosuppressed population.
Chernenko
Susan M
SM
Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Humar
Atul
A
Hutcheon
Michael
M
Chow
Chung-Wai
CW
Chaparro
Cecilia
C
Keshavjee
Shaf
S
Singer
Lianne G
LG
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015994:Incidence; D038622:Internationality; D008171:Lung Diseases / Q000188:drug therapy / Q000209:etiology; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D017192:Skin Diseases, Bacterial / Q000209:etiology / Q000601:surgery; D018461:Soft Tissue Infections / Q000209:etiology / Q000628:therapy; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents