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Mycobacterium abscessus infections in lung transplant recipients: 15‐year experience from a single institution
Author(s) -
Osmani Morsal,
Sotello David,
Alvarez Salvador,
Odell John A.,
Thomas Mathew
Publication year - 2018
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.12835
Subject(s) - medicine , mycobacterium abscessus , transplantation , surgery , cystic fibrosis , lung transplantation , nontuberculous mycobacteria , regimen , mycobacterium , pathology , tuberculosis
Purpose To evaluate our institutional experience with M ycobacterium abscessus infections occurring in lung transplant recipients ( LTR ). Methods We retrospectively reviewed our prospectively collected institutional adult lung transplant database from 2001 to 2015 to identify patients with M . abscessus or M ycobacterium chelonae/abscessus infection before or after transplantation. Untreated, colonized patients were excluded from the study. Electronic health records of nine out of 516 lung recipients (1.74%) with clinical infection were reviewed to determine outcomes. Results Seven patients acquired the infection after transplantation. Indications for transplantation were: idiopathic pulmonary fibrosis (in 6), chronic obstructive pulmonary disease (in 2), and cystic fibrosis (in 1). Five patients (55.5%) underwent bilateral lung transplantation; one patient required bilateral re‐transplantation for complications from infection. M . abscessus was isolated from the respiratory tract with a median time of 7.5 months (range: 3 days to 13 months) from transplantation. All patients were treated using a multidrug regimen, with durations ranging from 3 days to 12 months. Complications from infection included death in one patient, bronchial anastomotic dehiscence in one patient, delayed bronchial occlusions in two patients, and osteomyelitis of the knee in one patient. Median survival time from transplantation was 39 months (range: 11‐96 months) and from the date of first positive culture was 58 months (range: 3‐91 months). Five patients (55.5%) were cured but two had re‐infections >1 year later. Conclusions M ycobacterium abscessus infection in LTR is rare and can lead to severe complications. Eradication is difficult and usually requires prolonged combination antibiotic therapy and occasionally surgical management.