PURPOSE: Recent national guidelines recommended that patients post transplantation should be considered at risk for multidrug resistant (MDR) pathogens. Limited data is available regarding the impact of health care associated pneumonia (HCAP) in lung transplant recipients (LTR). Therefore, our aim was to evaluate the impact of HCAP in LTR compared to non-HCAP patients (hospital [HAP]/ventilator associated pneumonia [VAP]).
METHODS: A retrospective cohort study was conducted on LTR with pneumonia at one transplant center over a four year period. Eligible patients included all LTR that developed the first episode of pneumonia after 48 hours post transplantation with radiographic confirmation or anytime after transplantation (Range 48 hours to 57 months post-transplant). HCAP, HAP and VAP were classified according to the ATS/IDSA 2005 guidelines. Chi-square and Student s t-test were used to compare categorical and continuous variables, respectively.
RESULTS: 77 LTR were studied of which 48 were found to have the first episode of pneumonia (health care associated 65%, hospital acquired 8% and ventilator associated pneumonia 27%). Only 7 (15%) developed VAP early following transplantation, after 48 hours (no HAPs occurred). Groups were similar with respect to age, gender, comorbidities, APACHE II, and need for vasopressors. HCAP LTR were less likely to be on mechanical ventilation at the time of suspected pneumonia (29% vs. 59%, p=.04). Patients with HCAP had similar rates of Pseudomonas aeruginosa (26% vs. 29%, p=.8) and methicillin sensitive S. aureus (3% vs. 12%, p=.2) compared to patients without HCAP. LTR with HCAP had a similar mortality at 30- (16% vs. 12%, p=.7) and 90-days (23% vs. 12%, p=.4) compared to non-HCAP (HAP/VAP) patients.
CONCLUSION: HCAP is frequent in LTRs and no differences were observed related to clinical parameters, microbiology and mortality when compared to HAP and VAP LTR patients.
CLINICAL IMPLICATIONS: Further prospective studies are needed to evaluate the impact of HCAP in LTR patients.
DISCLOSURE: Juan Sanchez, No Financial Disclosure Information; No Product/Research Disclosure Information