title: Pneumonia in solid organ recipients: spectrum of pathogens in 217 episodes.
abstract: BACKGROUND
  Lower respiratory tract infection (LRTI) remains a leading cause of morbidity and mortality after solid organ transplantation (SOT).
  
  
  METHODS
  We performed a retrospective analysis of 217 episodes of LRTI in 143 SOT patients from a single center.
  
  
  RESULTS
  There were 94 men and 49 women (85% Caucasian) of median age of 51 (range 17-79) years, including 50 renal, 86 liver, 6 pancreas, and 1 lung recipient. Forty patients experienced multiple episodes of LRTI. Median APACHE II score was 17 (range 5-40), median temperature was 38 degrees C (range 35.3 degrees C-40.2 degrees C), and median white blood cell count was 12000 (range 100-106,000). Pneumonia developed at a median of 11 (range 2-191) days after the last surgical intervention. Of the 217 LRTIs, 163 were nosocomial infections (60 ventilator-associated). Overall crude mortality of 21% was increased in patients with multiple episodes of LRTI (25%) and after liver transplantation (33%). In 40 cases, treatment was initiated without identification of a specific pathogen. Overall, 202 microorganisms were found (41 mixed infections): Staphylococcus aureus (n = 32) of which 81% were MRSA; Escherichia coli (n = 9); Klebsiella spp (n = 7); Enterobacter spp (n = 11); Serratia spp (n = 12); Pseudomonas aeruginosa (n = 15); Stenotrophomonas maltophila (n = 15); Acinetobacter spp (n = 9); fungi (n = 18), and viruses (n = 17).
  
  
  CONCLUSIONS
  LRTI remains one of the most common, dangerous infections in transplant recipients with higher mortality than in other populations. MRSA is a particular problem. As a significant number of SOT patients develop multiple episodes of LRTI, a thorough reevaluation of the current guidelines for the treatment of pneumonia is urgently needed.
authors.affiliation: Department of Surgery, Division of Transplantation, University of Virginia Health System, Charlottesville, Virginia 22908-0709, USA.
authors.forename: H
authors.initials: H
authors.lastname: Bonatti
authors.forename: T L
authors.initials: TL
authors.lastname: Pruett
authors.forename: G
authors.initials: G
authors.lastname: Brandacher
authors.forename: K D
authors.initials: KD
authors.lastname: Hagspiel
authors.forename: A M
authors.initials: AM
authors.lastname: Housseini
authors.forename: C D
authors.initials: CD
authors.lastname: Sifri
authors.forename: R G
authors.initials: RG
authors.lastname: Sawyer
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D004927:Escherichia coli Infections / Q000453:epidemiology; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology; D055624:Methicillin-Resistant Staphylococcus aureus; D016377:Organ Transplantation / Q000009:adverse effects*; D011014:Pneumonia / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000382:microbiology; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology; D013997:Time Factors; D014777:Virus Diseases / Q000453:epidemiology