Complex Bacterial Infections Pre- and Posttransplant

ABSTRACT

Infections complications following lung transplantation are associated with significant morbidity and mortality. Management of infections is most challenging in patients with cystic fibrosis (CF), but all lung transplant recipients are at heightened risk for opportunistic infections. Particularly in CF, pretransplant infections with Pseudomonas aeruginosa, other highly resistant bacteria (e.g., Stenotrophomonas, Burkholderia), and mycobacteria play a major role in recipient selection and post–lung transplant outcomes. Understanding the clinical impact and management strategies for each of these different pathogens is critical to maximizing the benefit of lung transplantation. In the review, we discuss each of these infections both as pretransplant risk factors as well as posttransplant pathogens and the individual issues that arise with each infection.

KEYWORDS

Lung transplant - pneumonia - cystic fibrosis - Pseudomonas - mycobacteria - Burkholderia

REFERENCES

• 1 Bonvillain R W, Valentine V G, Lombard G, LaPlace S, Dhillon G, Wang G. Post-operative infections in cystic fibrosis and non-cystic fibrosis patients after lung transplantation.  J Heart Lung Transplant. 2007;  26 890-897
• 2 Aguilar-Guisado M, Givaldá J, Ussetti P RESITRA cohort et al. Pneumonia after lung transplantation in the RESITRA Cohort: a multicenter prospective study.  Am J Transplant. 2007;  7 1989-1996
• 3 Campos S, Caramori M, Teixeira R et al.. Bacterial and fungal pneumonias after lung transplantation.  Transplant Proc. 2008;  40 822-824
• 4 Valentine V G, Bonvillain R W, Gupta M R et al.. Infections in lung allograft recipients: ganciclovir era.  J Heart Lung Transplant. 2008;  27 528-535
• 5 Palmer S M, Alexander B D, Sanders L L et al.. Significance of blood stream infection after lung transplantation: analysis in 176 consecutive patients.  Transplantation. 2000;  69 2360-2366
• 6 Hadjiliadis D, Steele M P, Chaparro C et al.. Survival of lung transplant patients with cystic fibrosis harboring panresistant bacteria other than Burkholderia cepacia, compared with patients harboring sensitive bacteria.  J Heart Lung Transplant. 2007;  26 834-838
• 7 Orens J B, Estenne M, Arcasoy S Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation et al. International guidelines for the selection of lung transplant candidates: 2006 update—a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation.  J Heart Lung Transplant. 2006;  25 745-755
• 8 Kumar D, Cattral M S, Robicsek A, Gaudreau C, Humar A. Outbreak of Pseudomonas aeruginosa by multiple organ transplantation from a common donor.  Transplantation. 2003;  75 1053-1055
• 9 Walter S, Gudowius P, Bosshammer J et al.. Epidemiology of chronic Pseudomonas aeruginosa infections in the airways of lung transplant recipients with cystic fibrosis.  Thorax. 1997;  52 318-321
• 10 Holzmann D, Speich R, Kaufmann T et al.. Effects of sinus surgery in patients with cystic fibrosis after lung transplantation: a 10-year experience.  Transplantation. 2004;  77 134-136
• 11 Botha P, Archer L, Anderson R L et al.. Pseudomonas aeruginosa colonization of the allograft after lung transplantation and the risk of bronchiolitis obliterans syndrome.  Transplantation. 2008;  85 771-774
• 12 Vos R, Vanaudenaerde B M, Geudens N, Dupont L J, Van Raemdonck D E, Verleden G M. Pseudomonal airway colonisation: risk factor for bronchiolitis obliterans syndrome after lung transplantation?.  Eur Respir J. 2008;  31 1037-1045
• 13 Christenson J C, Welch D F, Mukwaya G, Muszynski M J, Weaver R E, Brenner D J. Recovery of Pseudomonas gladioli from respiratory tract specimens of patients with cystic fibrosis.  J Clin Microbiol. 1989;  27 270-273
• 14 Church A C, Sivasothy P, Parmer J, Foweraker J. Mediastinal abscess after lung transplantation secondary to Burkholderia gladioli infection.  J Heart Lung Transplant. 2009;  28 511-514
• 15 Jones A M, Stanbridge T N, Isalska B J, Dodd M E, Webb A K. Burkholderia gladioli: recurrent abscesses in a patient with cystic fibrosis.  J Infect. 2001;  42 69-71
• 16 Kanj S S, Tapson V, Davis R D, Madden J, Browning I. Infections in patients with cystic fibrosis following lung transplantation.  Chest. 1997;  112 924-930
• 17 Khan S U, Gordon S M, Stillwell P C, Kirby T J, Arroliga A C. Empyema and bloodstream infection caused by Burkholderia gladioli in a patient with cystic fibrosis after lung transplantation.  Pediatr Infect Dis J. 1996;  15 637-639
• 18 Bernhardt S A, Spilker T, Coffey T, LiPuma J J. Burkholderia cepacia complex in cystic fibrosis: frequency of strain replacement during chronic infection.  Clin Infect Dis. 2003;  37 780-785
• 19 Murray S, Charbeneau J, Marshall B C, LiPuma J J. Impact of Burkholderia infection on lung transplantation in cystic fibrosis.  Am J Respir Crit Care Med. 2008;  178 363-371
• 20 Kennedy M P, Coakley R D, Donaldson S H et al.. Burkholderia gladioli: five year experience in a cystic fibrosis and lung transplantation center.  J Cyst Fibros. 2007;  6 267-273
• 21 Glass S, Govan J R. Pseudomonas cepacia—fatal pulmonary infection in a patient with cystic fibrosis.  J Infect. 1986;  13 157-158
• 22 De Soyza A, Corris P A. Lung transplantation and the Burkholderia cepacia complex.  J Heart Lung Transplant. 2003;  22 954-958
• 23 Reik R, Spilker T, Lipuma J J. Distribution of Burkholderia cepacia complex species among isolates recovered from persons with or without cystic fibrosis.  J Clin Microbiol. 2005;  43 2926-2928
• 24 De Soyza A, McDowell A, Archer L et al.. Burkholderia cepacia complex genomovars and pulmonary transplantation outcomes in patients with cystic fibrosis.  Lancet. 2001;  358 1780-1781
• 25 Aris R M, Routh J C, LiPuma J J, Heath D G, Gilligan P H. Lung transplantation for cystic fibrosis patients with Burkholderia cepacia complex: survival linked to genomovar type.  Am J Respir Crit Care Med. 2001;  164 2102-2106
• 26 Alexander B D, Petzold E W, Reller L B et al.. Survival after lung transplantation of cystic fibrosis patients infected with Burkholderia cepacia complex.  Am J Transplant. 2008;  8 1025-1030
• 27 de Perrot M, Chaparro C, McRae K et al.. Twenty-year experience of lung transplantation at a single center: influence of recipient diagnosis on long-term survival.  J Thorac Cardiovasc Surg. 2004;  127 1493-1501
• 28 Goss C H, Otto K, Aitken M L, Rubenfeld G D. Detecting Stenotrophomonas maltophilia does not reduce survival of patients with cystic fibrosis.  Am J Respir Crit Care Med. 2002;  166 356-361
• 29 Korenromp E L, Bierrenbach A L, Williams B G, Dye C. The measurement and estimation of tuberculosis mortality.  Int J Tuberc Lung Dis. 2009;  13 283-303
• 30 Morales P, Briones A, Torres J J, Solé A, Pérez D, Pastor A. Pulmonary tuberculosis in lung and heart-lung transplantation: fifteen years of experience in a single center in Spain.  Transplant Proc. 2005;  37 4050-4055
• 31 Muñoz P, Rodríguez C, Bouza E. Mycobacterium tuberculosis infection in recipients of solid organ transplants.  Clin Infect Dis. 2005;  40 581-587
• 32 Schulman L L, Scully B, McGregor C C, Austin J H. Pulmonary tuberculosis after lung transplantation.  Chest. 1997;  111 1459-1462
• 33 Singh N, Paterson D L. Mycobacterium tuberculosis infection in solid-organ transplant recipients: impact and implications for management.  Clin Infect Dis. 1998;  27 1266-1277
• 34 Dromer C, Nashef S A, Velly J F, Martigne C, Couraud L. Tuberculosis in transplanted lungs.  J Heart Lung Transplant. 1993;  12(6 Pt 1) 924-927
• 35 Malouf M A, Glanville A R. The spectrum of mycobacterial infection after lung transplantation.  Am J Respir Crit Care Med. 1999;  160(5 Pt 1) 1611-1616
• 36 Aguado J M, Herrero J A, Gavaldá J et al.. Clinical presentation and outcome of tuberculosis in kidney, liver, and heart transplant recipients in Spain. Spanish Transplantation Infection Study Group, GESITRA.  Transplantation. 1997;  63 1278-1286
• 37 Boedefeld R L, Eby J, Boedefeld II W M et al.. Fatal Mycobacterium tuberculosis infection in a lung transplant recipient.  J Heart Lung Transplant. 2008;  27 1176-1178
• 38 Bravo C, Roldán J, Roman A et al.. Tuberculosis in lung transplant recipients.  Transplantation. 2005;  79 59-64
• 39 Lee J, Yew W W, Wong C F, Wong P C, Chiu C S. Multidrug-resistant tuberculosis in a lung transplant recipient.  J Heart Lung Transplant. 2003;  22 1168-1173
• 40 Fowler S J, French J, Screaton N J et al.. Nontuberculous mycobacteria in bronchiectasis: prevalence and patient characteristics.  Eur Respir J. 2006;  28 1204-1210
• 41 Olivier K N, Weber D J, Wallace Jr R J Nontuberculous Mycobacteria in Cystic Fibrosis Study Group et al. Nontuberculous mycobacteria. I: multicenter prevalence study in cystic fibrosis.  Am J Respir Crit Care Med. 2003;  167 828-834
• 42 Chalermskulrat W, Sood N, Neuringer I P et al.. Non-tuberculous mycobacteria in end stage cystic fibrosis: implications for lung transplantation.  Thorax. 2006;  61 507-513
• 43 Taylor J L, Palmer S M. Mycobacterium abscessus chest wall and pulmonary infection in a cystic fibrosis lung transplant recipient.  J Heart Lung Transplant. 2006;  25 985-988
• 44 Chernenko S M, Humar A, Hutcheon M et al.. Mycobacterium abscessus infections in lung transplant recipients: the international experience.  J Heart Lung Transplant. 2006;  25 1447-1455
• 45 Zaidi S, Elidemir O, Heinle J S et al.. Mycobacterium abscessus in cystic fibrosis lung transplant recipients: report of 2 cases and risk for recurrence.  Transpl Infect Dis. 2009;  11 243-248
• 46 Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association.  Am J Respir Crit Care Med. 1997;  156(2 Pt 2) S1-S25
• 47 Doucette K, Fishman J A. Nontuberculous mycobacterial infection in hematopoietic stem cell and solid organ transplant recipients.  Clin Infect Dis. 2004;  38 1428-1439