Bacterial infections following lung transplantation
- Scott M Palmer, MD, MHS
Scott M Palmer, MD, MHS
- Professor of Medicine
- Duke University Medical Center
- Aimee Zaas, MD, MHS
Aimee Zaas, MD, MHS
- Associate Professor of Medicine
- Duke University Medical Center
- Cameron Wolfe, MBBS (Hons)
Cameron Wolfe, MBBS (Hons)
- Director Biopreparedness
- Duke Preparedness & Response Center
- Division of Infectious Diseases
- Duke University
- Section Editors
- Elbert P Trulock, MD
Elbert P Trulock, MD
- Section Editor — Lung Transplantation
- Professor of Medicine
- Washington University School of Medicine
- Kieren A Marr, MD
Kieren A Marr, MD
- Section Editor — Compromised Host Infections; Fungal Infections
- Professor of Medicine and Oncology
- Johns Hopkins University School of Medicine
Lung transplantation is an effective treatment for a wide range of advanced lung diseases. While the survival of lung transplant recipients continues to improve, outcomes after lung transplantation remain inferior to other types of solid organ transplantation [1,2]. Infectious complications contribute substantially to morbidity and mortality following lung transplantation and account for over 25 percent of all posttransplant deaths .
This topic reviews the most common bacterial infections in lung transplant recipients. Infections caused by fungi, mycobacteria, and viruses in lung transplant recipients and general issues regarding infections in solid organ transplant recipients are discussed separately. (See "Fungal infections following lung transplantation" and "Tuberculosis in solid organ transplant candidates and recipients" and "Nontuberculous mycobacterial infections in solid organ transplant candidates and recipients" and "Prevention of cytomegalovirus infection in lung transplant recipients" and "Clinical manifestations, diagnosis, and treatment of cytomegalovirus infection in lung transplant recipients" and "Infection in the solid organ transplant recipient" and "Evaluation for infection before solid organ transplantation" and "Prophylaxis of infections in solid organ transplantation" and "Immunizations in solid organ transplant candidates and recipients".)
RISK OF INFECTION
Lung transplant recipients are at increased risk for infectious complications due to the following factors:
●The high level of immunosuppression required to prevent rejection
●Adverse effects of transplantation on local pulmonary host defenses (loss of lymphatics, reduced mucociliary clearance, decreased cough)
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- RISK OF INFECTION
- TIMELINE OF INFECTION
- EVALUATION FOR INFECTION
- Diagnostic approach
- BACTERIAL INFECTIONS
- Sites of infection
- - Pneumonia
- - Pleural space infections
- - Bloodstream infections
- - Skin and soft tissue infections
- Specific pathogens
- - Pseudomonas aeruginosa
- - Burkholderia cepacia
- - Other gram-negative bacteria
- - Staphylococcus aureus
- - Streptococcus pneumoniae
- - Chlamydia pneumoniae
- - Nocardia
- - Clostridium difficile
- - Mycoplasma hominis, Ureaplasma urealyticum, and hyperammonemia
- - Hospital-acquired, ventilator-associated, and healthcare-associated pneumonia
- - Community-acquired pneumonia
- - Duration
- Other infections
- Systemic antibiotics
- - Routine perioperative prophylaxis
- - Trimethoprim-sulfamethoxazole
- Positive lung cultures
- - Positive donor lung cultures
- - Positive native lung cultures
- Adjunctive strategies
- SUMMARY AND RECOMMENDATIONS