Premium
Effect of positive perioperative donor and recipient respiratory bacterial cultures on early post‐transplant outcomes in lung transplant recipients
Author(s) -
Howell Crystal K.,
Paciullo Christopher A.,
Lyon G. Marshall,
Neujahr David,
Lyu Peter,
Cotsonis George,
Hurtik Michael
Publication year - 2017
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12760
Subject(s) - medicine , bronchoalveolar lavage , regimen , clinical endpoint , lung transplantation , intensive care unit , transplantation , antibiotics , lung , intensive care medicine , randomized controlled trial , microbiology and biotechnology , biology
Background It is standard practice to administer prophylactic antibiotics post lung transplantation. However, no studies have evaluated the impact of culture positivity. The purpose of this study was to evaluate early post‐transplant outcomes of culture‐positive and culture‐negative lung transplant ( LT ) recipients and the appropriateness of the empiric regimens used. Methods Adult patients who received an LT at Emory University Hospital between January 1, 2010 and August 31, 2015 were reviewed and stratified into three groups: (i) culture‐positive appropriate empiric treatment, (ii) culture‐positive inappropriate empiric treatment, and (iii) culture‐negative. Antibiotics were defined as appropriate if bacteria were sensitive to the empiric regimen. The primary endpoint was 30‐day mortality. Secondary endpoints included hospital length of stay ( LOS ), intensive care unit ( ICU ) LOS , percent neutrophil count in a bronchoalveolar lavage ( BAL ) sample, presence of airway ischemia, and appropriateness of the empiric antibiotic regimen. Results Nine, zero, and four patients died within 30 days in the culture‐positive appropriate (n = 113), culture‐positive inappropriate (n = 5), and culture‐negative groups (n = 29) ( P = .564) respectively. The median hospital LOS was 19, 16, and 15 days respectively. Median ICU LOS was 6, 5, and 7 respectively. The respective percent neutrophil counts in the BAL fluid were 79, 83, and 65. The presence of airway ischemia was only documented in eight patients, all in the culture‐positive appropriate group. Conclusion We did not identify an association between antibiotic appropriateness and 30‐day mortality, hospital LOS , or ICU LOS in post‐ LT recipients.