The study evaluates the incidence, etiology, and types of bacterial and fungal infection in lung allograft donors. Likewise, it assesses the donor-to-host transmission. Patients and methods: 49 consecutive recipients of a lung allograft (1994-1997) who survived 24 h after the procedure and their respective donors were evaluated for the presence of donor bacterial-fungal infection and possible donor-to-host transmission. Antibioprophylaxis, including cefuroxime or amoxicillin-clavulanic plus aztreonam in the recipients who had a nonseptic underlying disease and two antimicrobials active against the microorganisms isolated in the last culture in those who had a septic underlying disease. The duration of antibioprophylaxis depended on results of the recipient and donor intraoperative cultures. Antifungal prophylaxis was performed with nebulized amphotericin B 6 mg/8h. We recorded all positive cultures of blood, respiratory specimens and preservation fluids from the donor at the moment of harvest and the episodes of infection in the recipient that appeared during the first two months after transplantation. Results: 36 out of 49 donors (73%) had 39 episodes of infection or colonization which including the following types: graft colonization 27 (55%), contamination of preservation fluids 7 (14%) and bacteremia 5 (10%). The majority of the episodes were due to Gram-positive cocci. Six graft colonizations by fungi (C. albicans 6, A. fumigatus 1). The microorganisms most frequently isolated from the respiratory secretions of colonized lung allografts were S. aureus (n=11) and H. influenzae (n=10). The frequency and etiology of lung allograft colonization was not associated with the length of mechanical ventilation or the cause of donor death (vascular stroke or cranial traumatism). Donor-to-host transmission of an infection occurred in 8 of 49 recipients (16.3%): mediastinitis due to Aspergillus fumigatus 1, pneumonia 3 (2 due S. aureus, 1 due K. pneumoniae plus E. coli) and purulent tracheobronchitis 4(S. aureus 2, P. aeruginosa 1, and S. maltophila 1). Two patients died related to the donor-to-host transmission of infection (mediastinitis, pneumonia due S.aureus). Conclusions: Donor infection is a frequent event in lung transplantation. Our prophylactic strategy is effective in preventing donor-to-host transmission of bacterial and fungal infections.
Full conference title:
38th Interscience Conference on Antimicrobial Agents and Chemotherapy
- ICAAC 38th