Understanding the Concept of Health Care-Associated Pneumonia in Lung Transplant Recipients

• Published in: Chest Vol. 148; no. 2; p. 516
• Main Authors: Palacio, Federico, Reyes, Luis F, Levine, Deborah J, Sanchez, Juan F, Angel, Luis F, Fernandez, Juan F, Levine, Stephanie M, Rello, Jordi, Abedi, Ali, Restrepo, Marcos I
• Format: Journal Article
• Language: English
• Published: United States 01.08.2015
• Subjects: Anti-Bacterial Agents - therapeutic use; Cohort Studies; Cross Infection - chemically induced; Cross Infection - drug therapy; Cross Infection - microbiology; Drug Resistance, Multiple, Bacterial; Female; Graft Rejection - prevention & control; Humans; Immunosuppressive Agents - adverse effects; Lung Transplantation; Male; Middle Aged; Pneumonia - chemically induced; Pneumonia - drug therapy; Pneumonia - microbiology; Pneumonia, Ventilator-Associated - chemically induced; Pneumonia, Ventilator-Associated - drug therapy; Pneumonia, Ventilator-Associated - microbiology; Retrospective Studies
• ISSN: 1931-3543
• DOI: 10.1378/chest.14-1948

Limited data are available regarding the etiologic impact of health care-associated pneumonia (HCAP) in lung transplant recipients. Therefore, our aim was to evaluate the microbiologic differences between HCAP and hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) in lung transplant recipients with a radiographically confirmed diagnosis of pneumonia. We performed a retrospective cohort study of lung transplant recipients with pneumonia at one transplant center over a 7-year period. Eligible patients included lung transplant recipients who developed a first episode of radiographically confirmed pneumonia ≥ 48 h following transplantation. HCAP, HAP, and VAP were classified according to the American Thoracic Society/Infectious Diseases Society of America 2005 guidelines. χ² and Student t tests were used to compare categorical and continuous variables, respectively. Sixty-eight lung transplant recipients developed at least one episode of pneumonia. HCAP (n = 42; 62%) was most common, followed by HAP/VAP (n = 26; 38%) stratified in HAP (n = 20; 77%) and VAP (n = 6; 23%). Pseudomonas aeruginosa was the predominantly isolated organism (n = 22; 32%), whereas invasive aspergillosis was uncommon (< 10%). Multiple-drug resistant (MDR) pathogens were less frequently isolated in patients with HCAP compared with HAP/VAP (5% vs 27%; P = .009). Opportunistic pathogens were less frequently identified in lung transplant recipients with HCAP than in those with HAP/VAP (7% vs 27%; P = .02). Lung transplant recipients with HCAP had a similar mortality at 90 days (n = 9 [21%] vs n = 4 [15%]; P = .3) compared with patients with HAP/VAP. HCAP was the most frequent infection in lung transplant recipients. MDR pathogens and opportunistic pathogens were more frequently isolated in HAP/VAP. There were no differences in 30- and 90-day mortality between lung transplant recipients with HCAP and those with HAP/VAP.