Survival after lung transplantation of cystic fibrosis patients infected with Burkholderia cepacia complex.
Within the Burkholderia cepacia complex (Bcc), B. cenocepacia portends increased mortality compared with other species. We investigated the impact of Bcc infection on mortality and re-infection following lung transplant (LT). Species designation for isolates from Bcc-infected patients was determined using 16S rDNA and recA gene analyses. Of 75 cystic fibrosis patients undergoing LT from September 1992 to August 2002, 59 had no Bcc and 16 had Bcc (including 7 B. cenocepacia) isolated in the year before LT. Of the latter, 87.5% had Bcc recovered after transplantation, and all retained their pretransplant strains. Survival was 97%, 92%, 76% and 63% for noninfected patients; 89%, 89%, 67% and 56% for patients infected with Bcc species other than B. cenocepacia; and 71%, 29%, 29% and 29% for patients with B. cenocepacia (p = 0.014) at 1 month, 1 year, 3 years and 5 years, respectively. Patients infected with B. cenocepacia before transplant were six times more likely to die within 1 year of transplant than those infected with other Bcc species (p = 0.04) and eight times than noninfected patients (p < 0.00005). Following LT, infection with Bcc species other than B. cenocepacia does not significantly impact 5-year survival whereas infection with B. cenocepacia pretransplant is associated with decreased survival.
Alexander
B D
BD
Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Durham, NC, USA. alexa011@mc.duke.edu
Petzold
E W
EW
Reller
L B
LB
Palmer
S M
SM
Davis
R D
RD
Woods
C W
CW
Lipuma
J J
JJ
D000328:Adult; D019121:Burkholderia Infections / Q000150:complications* / Q000401:mortality; D042602:Burkholderia cepacia complex; D003550:Cystic Fibrosis / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors