title: Incidence of nosocomial pneumonia and risk of recurrence after antimicrobial therapy in critically ill lung and heart-lung transplant patients.
abstract: Little is known about the resolution of symptoms of nosocomial pneumonia (NosoP) after lung and heart-lung transplantation. The aim of this study was to describe the clinical response to antimicrobial therapy in (ICU) patients with NosoP after lung or heart-lung transplantation. Between January 2008 and August 2010, 79 lung or heart-lung transplantations patients were prospectively studied. NosoPwas confirmed by quantitative cultures of bronchoalveolar lavage or endotracheal aspirates. Clinical variables, sequential organ failure assessment (SOFA) score, and radiologic score were recorded from start of therapy until day 9. Thirty-five patients (44%) experienced 64 episodes of NosoP in ICU. Fourteen patients (40%) had NosoP recurrence. Most frequently isolated organisms were Enterobacteriaceae (30%), Pseudomonas aeruginosa (25%), and Staphylococcus aureus (20%). Sequential organ failure assessment (SOFA) score improved significantly at day 6 and C-reactive protein level at day 9. SOFA and radiologic scores differed significantly between patients with and without NosoP recurrence at day 3 and 9. The ICU mortality rate did not differ between patients with and without NosoP recurrence, and free of NosoP (14.3%, 9.5%, 11.4%, respectively) (p = 0.91). Severities of illness and lung injury were the two major risk factors for NosoP recurrence. Occurrence of NosoP has no impact on ICU mortality.
authors.affiliation: Surgical intensive care unit, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
authors.forename: Daniela
authors.initials: D
authors.lastname: Dudau
authors.forename: Julien
authors.initials: J
authors.lastname: Camous
authors.forename: Séverine
authors.initials: S
authors.lastname: Marchand
authors.forename: Catherine
authors.initials: C
authors.lastname: Pilorge
authors.forename: Saïda
authors.initials: S
authors.lastname: Rézaiguia-Delclaux
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Libert
authors.forename: Elie
authors.initials: E
authors.lastname: Fadel
authors.forename: François
authors.initials: F
authors.lastname: Stéphan
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016638:Critical Illness; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D016041:Heart-Lung Transplantation; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: heart-lung transplantation; lung transplantation; multidrug-resistant bacteria; nosocomial pneumonia