Postoperative antimicrobials after lung transplantation and the development of multidrug‐resistant bacterial and C lostridium difficile infections: an analysis of 500 non‐cystic fibrosis lung transplant patients

Background Broad‐spectrum antimicrobials are given prophylactically post‐transplant, although these agents are a risk factor for multidrug‐resistant ( MDR ) infections and Clostridium difficile infection ( CDI ). This study aimed to determine whether an association exists between the duration of antimicrobials given early post‐transplant and the development of MDR infections or CDI . Methods A single‐center retrospective analysis was performed on lung transplants from September 2009 to August 2014. Patients were excluded for cystic fibrosis ( CF ) or postoperative survival less than 30 d. Qualifying infections were defined as any new positive MDR bacterial culture or C. difficile assay from postoperative day 7–90 d after a broad‐spectrum antimicrobial. Results A total of 500 patients, 61% male, were identified, median age of 62 yr. MDR infections occurred in 169 (34%) and CDI in 31 (6%). Non‐ ICU days were associated with a decreased risk of MDR / CDI ( OR 0.891, p = 0.0002), and duration of Gram‐positive antimicrobials ( OR 1.073, p = 0.0219) was associated with an increased risk. Conclusions One‐third (34%) of non‐ CF lung transplants develop MDR infections and 6% develop CDI within 90 d of postoperative antimicrobials. The duration of Gram‐positive antimicrobials may increase the risk of MDR / CDI , while early transfer from the ICU may have a protective effect.