Acute respiratory failure among lung transplant adults requiring intensive care: Changing spectrum of causative organisms and impact of procalcitonin test in the diagnostic workup
| Autor: | Yolanda Peña, Antonio Roman, Jordi Rello, Anabel Romero, A. Gómez, Teresa Pont, Sofia Tejada, C. Mazo, Laura Campogiani |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Critical Care Exacerbation Bronchiolitis obliterans 030230 surgery Procalcitonin 03 medical and health sciences 0302 clinical medicine Interquartile range Intensive care Internal medicine medicine Humans Prospective Studies Transplantation business.industry Bacterial pneumonia medicine.disease Intensive Care Units Pneumonia Infectious Diseases Viral pneumonia 030211 gastroenterology & hepatology Respiratory Insufficiency business Biomarkers Lung Transplantation |
| Zdroj: | Transplant Infectious Disease. 22 |
| ISSN: | 1399-3062 1398-2273 |
| Popis: | BACKGROUND The aim was to identify the causing organisms and assess the association of procalcitonin (PCT) with bacterial pneumonia within 24 hours of intensive care unit admission (ICU-A) among lung transplant (LT) adult recipients. METHODS Secondary analysis from a prospective cohort study. All LT adults admitted to ICU for acute respiratory failure (ARF) over 5 years were included. Patients were followed until hospital discharge or death. RESULTS Fifty-eight consecutive LT patients were enrolled. The most important cause of ICU-A due to ARF was pneumonia 29 (50%) followed by acute rejection 3 (5.2%) and bronchiolitis obliterans syndrome exacerbation 3 (5.2%). Microorganisms were isolated from 22/29 cases with pneumonia (75.9%): 17 (77.2%) bacterial, 4 (18.2%) viral, 1 (4.5%) Aspergillus fumigates, with Pseudomonas aeruginosa being the most common cause (45.5%) of pneumonia, with 10 patients presenting chronic colonization by P aeruginosa. Median [Interquartile range (IQR)] PCT levels within 24 hours after admission were higher in pneumonia (1.5 µg/L; IQR:0.3-22.0), than in non-pneumonia cases (0.2 µg/L; IQR:0.1-0.7) (P = .019) and PCT levels within 24 hours helped to discriminate bacterial pneumonia (8.2 µg/L; IQR:0.2-43.0) from viral pneumonia and non-pneumonia cases (0.2 µg/L; IQR:0.1-0.7). The overall negative predictive value for bacterial pneumonia was 85.1%, increasing to 91.6% among episodes after 6 months of LT. CONCLUSIONS Causes of severe pneumonia in LT are changing, with predominant role of P aeruginosa and respiratory viruses. PCT ≤ 0.5 μg/L within 24 hours helps to exclude bacterial pneumonia diagnosis in LT adults requiring ICU-A. A negative PCT test allows antimicrobial de-escalation and requires an alternative diagnostic to bacterial pneumonia. |
| Databáze: | OpenAIRE |
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