Staphylococcus aureus infections in the early period after lung transplantation: epidemiology, risk factors, and outcomes.
| Autor: | Shields RK; Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA., Clancy CJ, Minces LR, Kwak EJ, Silveira FP, Abdel Massih RC, Toyoda Y, Bermudez C, Bhama JK, Shigemura N, Pilewski JM, Crespo M, Hong Nguyen M |
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| Jazyk: | angličtina |
| Zdroj: | The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2012 Nov; Vol. 31 (11), pp. 1199-206. Date of Electronic Publication: 2012 Sep 15. |
| DOI: | 10.1016/j.healun.2012.08.012 |
| Abstrakt: | 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. (Published by Elsevier Inc.) |
| Databáze: | MEDLINE |
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