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Clinical Investigations in Critical Care |

Etiology and Microbial Patterns of Pulmonary Infiltrates in Patients With Orthotopic Liver Transplantation*

Antoni Torres, MD; Santiago Ewig, MD; Jesus Insausti, MD; Juan Maria Guergué, MD; Antoni Xaubet, MD; Antoni Mas, MD; Juan Manuel Salmeron, MD
Author and Funding Information

Affiliations: *From Servei de Pneumologia i Al.lèrgia Respiratoria (Drs. Torres, Ewig, Insausti, Guergué, and Xaubet) and Servei de Hepatologia (Drs. Mas and Salmeron), Departament de Medicina, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Universitat de Barcelona, Barcelona, Spain. Supported by Commisionat per a Universitats i Recerca de la Generalitat de Catalunya 1997, Suport dels Grups de Recerca (SGR) 00086, IDIBAPS, and Fondo de Investigacion Sanitaria (FIS) 1131. ,  Dr. Santiago Ewig is a research fellow from the Medizinische Universitätsklinik und Poliklinik Bonn, Bonn, Germany. ,  Drs. Jesus Insausti and Juan Maria Guergué are research fellows from the Nafarroako Ospitalea, Pamplona-Iruna, Spain.

Correspondence to: Antoni Torres, MD, Hospital Clinic i Provincial, Servei de Pneumologia i Al.lergia Respiratoria, Villarroel, 170, 08036 Barcelona, Spain; e-mail:atorres@medicina.ub.es



Chest. 2000;117(2):494-502. doi:10.1378/chest.117.2.494
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Study objective: To evaluate the etiology and microbial patterns of pulmonary infiltrates in liver transplant patients using a bronchoscopic diagnostic approach and the impact of diagnostic results on antimicrobial treatment decisions.

Design: A prospective cohort study.

Setting: A 1,000-bed tertiary-care university hospital.

Patients and methods: Fifty consecutive liver transplant patients with 60 episodes of pulmonary infiltrates (33 episodes during mechanical ventilation) were studied using flexible bronchoscopy with protected specimen brush (PSB) and BAL.

Results: A definite infectious etiology was confirmed in 29 episodes (48%). Eighteen episodes corresponded to probable pneumonia (30%), 10 episodes had noninfectious etiologies (17%), and 3 remained undetermined (5%). Opportunistic infections were the most frequent etiology (16/29, 55%, including 1 mixed etiology). Bacterial infections (mainly Gram-negative) accounted for 14 of 29 episodes (48%), including 1 of mixed etiology. The majority of bacterial pneumonia episodes (n = 10, 71%) occurred in period 1 (1 to 28 days posttransplant) during mechanical ventilation, whereas opportunistic episodes were predominant in periods 2 and 3 (29 to 180 days and> 180 days posttransplant, respectively; n = 14, 82%). Microbial treatment was changed according to diagnostic results in 21 episodes (35%).

Conclusions: Microbial patterns in liver transplant patients with pulmonary infiltrates corresponded to nosocomial, mainly Gram-negative bacterial pneumonia in period 1, and to opportunistic infections in period 2 and, to a lesser extent, period 3. A comprehensive diagnostic evaluation including PSB and BAL fluid examination frequently guided specific antimicrobial therapy.


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