title: Staphylococcus aureus infections in the early period after lung transplantation: epidemiology, risk factors, and outcomes.
abstract: BACKGROUND
  Staphylococcus aureus infections among lung transplant recipients are poorly studied.
  
  
  METHODS
  We conducted a 5-year retrospective study of the epidemiology, clinical manifestations, risk factors, and outcomes of patients infected with S aureus within the first 90 days after lung transplantation.
  
  
  RESULTS
  An S aureus infection developed in 109 of 596 lung transplant (18%) recipients. Methicillin-susceptible S aureus (MSSA; 62%) was more common than methicillin-resistant S aureus (MRSA; 38%); however, the proportion of infections caused by MRSA increased over time. Pneumonia (48%) was the most common infection, followed by tracheobronchitis (26%), bacteremia (12%), intrathoracic infections (7%), and skin/soft tissue infections (7%). Risk factors included mechanical ventilation for > 5 days and isolation of S aureus from recipients' sterility cultures. Patients with MRSA cultured from the nares or respiratory tract at the time of transplant were at an increased risk for MRSA infection (p < 0.0001 and p = 0.02, respectively). Infected patients required longer hospital and intensive care unit stays (p < 0.0001 for both), but the 30- and 90-day mortality rates from the onset of infection were only 7% and 12%, respectively. However, infected patients had higher rates of acute and chronic rejection at 1 (p = 0.048) and 3 years (p = 0.002), and higher rates of mortality at 1 (p = 0.058) and 3 years (p = 0.009).
  
  
  CONCLUSIONS
  S aureus infections within the first 90 days of lung transplant were associated with low short-term mortality but increased long-term rates of mortality and acute and chronic rejection. Future studies are needed to explore the utility of S aureus eradication strategies in reducing disease burden and improving outcomes.
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Shields
authors.forename: Cornelius J
authors.initials: CJ
authors.lastname: Clancy
authors.forename: Lucio R
authors.initials: LR
authors.lastname: Minces
authors.forename: Eun J
authors.initials: EJ
authors.lastname: Kwak
authors.forename: Fernanda P
authors.initials: FP
authors.lastname: Silveira
authors.forename: Rima C
authors.initials: RC
authors.lastname: Abdel Massih
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
authors.forename: Christian
authors.initials: C
authors.lastname: Bermudez
authors.forename: Jay K
authors.initials: JK
authors.lastname: Bhama
authors.forename: Norihisa
authors.initials: N
authors.lastname: Shigemura
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Pilewski
authors.forename: Maria
authors.initials: M
authors.lastname: Crespo
authors.forename: M
authors.initials: M
authors.lastname: Hong Nguyen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000382:microbiology*; D016040:Lung Transplantation / Q000401:mortality; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D013211:Staphylococcus aureus / Q000145:classification* / Q000302:isolation & purification*; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult