Understanding the Concept of Health Care-Associated Pneumonia in Lung Transplant Recipients.
BACKGROUND
Limited data are available regarding the etiologic impact of health care-associated pneumonia (HCAP) in lung transplant recipients. Therefore, our aim was to evaluate the microbiologic differences between HCAP and hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) in lung transplant recipients with a radiographically confirmed diagnosis of pneumonia.


METHODS
We performed a retrospective cohort study of lung transplant recipients with pneumonia at one transplant center over a 7-year period. Eligible patients included lung transplant recipients who developed a first episode of radiographically confirmed pneumonia ≥ 48 h following transplantation. HCAP, HAP, and VAP were classified according to the American Thoracic Society/Infectious Diseases Society of America 2005 guidelines. χ² and Student t tests were used to compare categorical and continuous variables, respectively.


RESULTS
Sixty-eight lung transplant recipients developed at least one episode of pneumonia. HCAP (n = 42; 62%) was most common, followed by HAP/VAP (n = 26; 38%) stratified in HAP (n = 20; 77%) and VAP (n = 6; 23%). Pseudomonas aeruginosa was the predominantly isolated organism (n = 22; 32%), whereas invasive aspergillosis was uncommon (< 10%). Multiple-drug resistant (MDR) pathogens were less frequently isolated in patients with HCAP compared with HAP/VAP (5% vs 27%; P = .009). Opportunistic pathogens were less frequently identified in lung transplant recipients with HCAP than in those with HAP/VAP (7% vs 27%; P = .02). Lung transplant recipients with HCAP had a similar mortality at 90 days (n = 9 [21%] vs n = 4 [15%]; P = .3) compared with patients with HAP/VAP.


CONCLUSIONS
HCAP was the most frequent infection in lung transplant recipients. MDR pathogens and opportunistic pathogens were more frequently isolated in HAP/VAP. There were no differences in 30- and 90-day mortality between lung transplant recipients with HCAP and those with HAP/VAP.
South Texas Veterans Health Care System, San Antonio, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX.
Federico
F
Palacio
University of Texas Health Science Center at San Antonio, San Antonio, TX; Universidad de La Sabana, Bogota, Colombia.
Luis F
LF
Reyes
South Texas Veterans Health Care System, San Antonio, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX.
Deborah J
DJ
Levine
Scott and White Health Care System, Temple, TX.
Juan F
JF
Sanchez
University of Texas Health Science Center at San Antonio, San Antonio, TX.
Luis F
LF
Angel
University of Texas Health Science Center at San Antonio, San Antonio, TX.
Juan F
JF
Fernandez
South Texas Veterans Health Care System, San Antonio, TX.
Stephanie M
SM
Levine
Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, CIBERES, Universitat Autonoma de Barcelona, Barcelona, Spain).
Jordi
J
Rello
University of Texas Health Science Center at San Antonio, San Antonio, TX.
Ali
A
Abedi
South Texas Veterans Health Care System, San Antonio, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX. Electronic address: restrepom@uthscsa.edu.
Marcos I
MI
Restrepo
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003428:Cross Infection / Q000139:chemically induced / Q000188:drug therapy / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000139:chemically induced / Q000188:drug therapy / Q000382:microbiology*; D053717:Pneumonia, Ventilator-Associated / Q000139:chemically induced / Q000188:drug therapy / Q000382:microbiology*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents