Analysis of Donor to Recipient Pathogen Transmission in Relation to Cold Ischemic Time and Other Selected Aspects of Lung Transplantation—Single Center Experience
Abstract
:1. Introduction
2. Materials and Methods
2.1. Microbiological Testing
- Donor bronchial aspirate (DBA)—during the final bronchoscopic organ assessment by the surgeon in the operating theater of the donor home hospital.
- Graft endobronchial swab (GES, surgical material)—during its preparation before implantation in the recipient’s operating theater.
- Recipient cultures (RC) before transplantation (nose and throat swabs, sputum, and urine)—after the recipient arrives at the hospital.
- Recipient bronchial aspirate (RBA)—during the first and subsequent bronchofiberoscopies performed within 7 days after the transplant procedure.
2.2. Graft Preservation
2.3. Antimicrobial Therapy
2.4. Statistical Analysis
3. Results
3.1. Recipients
3.2. Donors
3.3. Donor Bronchial Aspirates
3.4. Graft Endobronchial Swab (Surgical Material)
3.5. Recipient Cultures before Transplantation
3.6. Recipient’s Bronchial Aspirates
3.7. Postoperative Course
3.8. Survival
3.9. Analysis of Antimicrobial Therapy
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Population (n = 59) | Mean | SD | Median | Lower Quartile | Upper Quartile | Range | p-Value | |
---|---|---|---|---|---|---|---|---|
Age (years) | 49.66 | 13.33 | 57 | 39 | 59 | 20–65 | <0.001 | |
ICU stay * (days) | n = 46 78.0% | 13.15 | 15.12 | 7 | 4.75 | 14.5 | 2–62 | <0.001 |
Hospitalization (days) | 33.97 | 14.83 | 31 | 24 | 41 | 7–73 | <0.001 | |
Survival on 21 December 2019 | n = 33 55.9% | 921.37 | 757.85 | 848 | 277 | 1445 | 7–2922 | <0.01 |
Population (n = 59) | Mean | SD | Median | Lower Quartile | Upper Quartile | Range | p-Value | |
---|---|---|---|---|---|---|---|---|
Age (years) | 39.78 | 13.12 | 41 | 30 | 50 | 11–61 | p = 0.08 | |
ICU stay (hours) | 105.92 | 77.02 | 109 | 42 | 142 | 8–334 | p < 0.01 | |
CIT 1 (min) | 59/100% | 403.27 | 107.02 | 400 | 330 | 480 | 150–630 | p = 0.69 |
CIT 2 (min) | 42/71.2% | 541.74 | 114.14 | 540 | 477.5 | 600 | 270–740 | p = 0.38 |
Donor Bronchial Aspirate (n = 53) | Graft Endobronchial Swabs (n = 59) | Recipient Bronchial Aspirates (n = 59) | Recipient Cultures (n = 59) | |
---|---|---|---|---|
Gram-positive bacteria | ||||
Staphylococcus aureus MSSA | 8 | 15 | 2 | 13 |
Staphylococcus aureus MRSA | 1 | |||
Staphylococcus auricularis | 1 | |||
Staphylococcus haemolyticus MRCNS, MLS | 1 | 1 | 1 | |
Staphylococcus epidermidis MRCNS, MRSE, MLS | 4 | 4 | ||
Staphylococcus lugudensis | 1 | |||
Staphylococcus hominis MSCNS | 1 | |||
Streptococcus anginosus | 1 | |||
Streptococcus agalactea MLS | 1 | |||
Enterococcus faecalis | 2 | 3 | ||
Enterococcus fecium | 1 | 1 | ||
Enterococcus casseliflavus | 1 | |||
Corynebacterium ulcerans | 1 | |||
Gram-negative bacteria | ||||
Enterobacter cloace | 2 | 4 | 4 | |
Klebsiella pneumoniae | 4 | 5 | 2 | 7 |
Klebsiella oxytoca | 1 | 2 | 1 | |
Escherichia coli | 2 | 5 | 2 | |
Proteus mirabilis | 1 | 1 | 2 | |
Haemofilus influenzae | 1 | 1 | ||
Citrobacter freundii | 1 | 1 | 1 | |
Moraxella catharralis | 1 | |||
Serratia odorifera | 1 | 1 | ||
Serratia marcescens | 1 | |||
Stenotrophomonas maltophilia | 1 | |||
Pseudomonas aeruginosa | 2 | 5 | 9 | |
Acinetobacter baumannii | 4 | 7 | 5 | |
Achromobacter xylosoxidans | 1 | |||
Fungi | ||||
Candida glabrata | 2 | 2 | 3 | 2 |
Candida albicans | 5 | 17 | 6 | 29 |
Candida crusei | 2 | 1 | ||
Candida tropicalis | 1 | |||
Candida parapsylosis | 1 | |||
Candida fumata | 1 |
Number of Strains | 1 | 2 a | 3 a | 4 a | 5 a | 6 a | 7 a |
---|---|---|---|---|---|---|---|
Material collection | (-)/ GES | DBA/ GES | DBA/ GES/ RBA | DBA/ GES/ RBA | DBA/ GES/ RBA | GES/ RBA | GES/ RBA |
Drug sensitivity | |||||||
Piperacillin+ tazobactam | R | R | R | R | |||
Ticarcillin + clavulanic acid | S | R | |||||
Ampicillin+ sulbactam | S | R | R | MIC 16 | MS | R | S MS |
Ceftazidime | R | ||||||
Cefepime | S | R | R | MS | R | MS | R |
Cefotaxime | R | R | |||||
Ciprofloxacin | S | R | R | R | R | R | R |
Levofloxacin | R | R | R | ||||
Imipenem | S | R | R | R | R | R | R |
Meropenem | R | R | R | R | R | R | |
Gentamicin | S | R | R | R | S | S MS S | R |
Tobramycin | R | R | |||||
Amikacin | R | R MS | S | R | R MS | R MS | |
Colistin | S | S | S | S | S | S | |
Tetracycline | R | ||||||
Trimethoprim + sulfamethoxazole | S | R | R | R | R | R | R |
Parameter | Prolonged Intubation | Non-Prolonged Intubation | p Value | ||||
---|---|---|---|---|---|---|---|
n | Mean SD (Range) | Median (Range) | n | Mean SD (Range) | Median (Range) | ||
Age (years) | 26 | 45 13.88 (21–65) | 43 (33–58) | 33 | 52 12.15 (20–64) | 57 (50–59.75) | 0.049 |
CIT 1 (min) | 26 | 440 102.48 (245–630) | 420 (360–519) | 33 | 374.09 102.77 (150–570) | 360 (303.75–435) | 0.029 |
CIT 2 (min) | 21 | 584 101.45 (380–740) | 600 (495–660) | 21 | 498 111.82 (277–690) | 495 (412.5–580) | 0.016 |
ICU stay (days) | 22 | 21 18.36 (5–62) | 13 (7.5–29.5) | 24 | 5 3.20 (2–16) | 5 (3–6) | <0.001 |
Hospitalization (days) | 26 | 40 19.08 (7–73) | 35 (73–23.5) | 33 | 29 7.79 (16–53) | 27 (24–32.75) | 0.032 |
p Value | HR (95%CI) | |
---|---|---|
DBA+ | 0.37 | 0.690 (0.309–1.539) |
GES+ | 0.02 * | 0.348 (0.144–0.842) |
DBA-/GES+ | 0.03 * | 0.322 (0.115–0.908) |
RC+ | 0.84 | 0.911 (0.362–2.291) |
RBA+ | 0.44 | 1.369 (0.619–3.028) |
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Piotrowska, M.; Wojtyś, M.E.; Kiełbowski, K.; Bielewicz, M.; Wasilewski, P.; Safranow, K.; Grodzki, T.; Kubisa, B. Analysis of Donor to Recipient Pathogen Transmission in Relation to Cold Ischemic Time and Other Selected Aspects of Lung Transplantation—Single Center Experience. Pathogens 2023, 12, 306. https://doi.org/10.3390/pathogens12020306
Piotrowska M, Wojtyś ME, Kiełbowski K, Bielewicz M, Wasilewski P, Safranow K, Grodzki T, Kubisa B. Analysis of Donor to Recipient Pathogen Transmission in Relation to Cold Ischemic Time and Other Selected Aspects of Lung Transplantation—Single Center Experience. Pathogens. 2023; 12(2):306. https://doi.org/10.3390/pathogens12020306
Chicago/Turabian StylePiotrowska, Maria, Małgorzata Edyta Wojtyś, Kajetan Kiełbowski, Michał Bielewicz, Piotr Wasilewski, Krzysztof Safranow, Tomasz Grodzki, and Bartosz Kubisa. 2023. "Analysis of Donor to Recipient Pathogen Transmission in Relation to Cold Ischemic Time and Other Selected Aspects of Lung Transplantation—Single Center Experience" Pathogens 12, no. 2: 306. https://doi.org/10.3390/pathogens12020306