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Original Research: Transplantation |

Understanding the Concept of Health Care-Associated Pneumonia in Lung Transplant RecipientsHealth Care-Associated Pneumonia and Transplants

Federico Palacio, MD; Luis F. Reyes, MD; Deborah J. Levine, MD, FCCP; Juan F. Sanchez, MD, FCCP; Luis F. Angel, MD, FCCP; Juan F. Fernandez, MD; Stephanie M. Levine, MD, FCCP; Jordi Rello, MD, PhD; Ali Abedi, MD; Marcos I. Restrepo, MD, FCCP
Author and Funding Information

From the South Texas Veterans Health Care System (Drs Palacio, S. M. Levine, and Restrepo), San Antonio, TX; the University of Texas Health Science Center at San Antonio (Drs Palacio, Reyes, D. J. Levine, Angel, Fernandez, S. M. Levine, Abedi, and Restrepo), San Antonio, TX; Scott and White Health Care System (Dr Sanchez), Temple, TX; the Hospital Universitari Vall d’Hebron (Dr Rello), Vall d’Hebron Institute of Research, CIBERES, Universitat Autonoma de Barcelona, Barcelona, Spain; and the Universidad de La Sabana (Dr Reyes), Bogota, Colombia.

CORRESPONDENCE TO: Marcos I. Restrepo, MD, FCCP, South Texas Veterans Health Care System, Audrey L. Murphy Division, 7400 Merton Minter Blvd, San Antonio, TX 78229; e-mail: restrepom@uthscsa.edu


FUNDING/SUPPORT: Dr Restrepo receives support from the National Heart, Lung and Blood Institute [Award K23HL096054].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(2):516-522. doi:10.1378/chest.14-1948
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BACKGROUND:  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.

METHODS:  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.

RESULTS:  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.

CONCLUSIONS:  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.


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