In a study published in Clinical Infectious Diseases, researchers conducted a single-center prospective study to ascertain the incidence of early pneumonia in patients post lung transplantation, investigate associated factors and pathogen origin, and assess morbidity and mortality correlated to pneumonia in the first-month post transplantation.

The study population consisted of patients at a single institution who received lung transplants (LTs) between July 2019 and January 2020 and October 2021 and November 2022.

Data collection involved evaluating the incidence and presentation of pneumonia, assessing the impact of associated factors employing regression models, and investigating the molecular association of respiratory pathogens collected peri transplant and at pneumonia occurrence using pulsed-field gel electrophoresis.

A total of 270 consecutive LT recipients (average age, 64 years; women, 38%; double-LT recipients, 90%) were involved in the study, with the most frequent indication for lung transplantation reported as interstitial lung disease (50%). A proven or possible pneumonia diagnosis within 30 days of transplantation was confirmed in 25 transplant recipients, 17 (68%) of whom had ventilator-assisted pneumonia and eight (32%) of whom had hospital-acquired pneumonia, with a median time to pneumonia of 11 days post transplantation.

Among the 25 patients with pneumonia, 24% were reported having a fever and 52% had leukocytosis or leukopenia. Additionally, in the first month, patients with pneumonia were prescribed antimicrobials for 18 days, while patients without pneumonia were prescribed antimicrobials for 10 days.

An estimated 49% of donor respiratory cultures were positive, with both gram-positive (57%) and gram-negative (44%) pathogens, while 16% of recipient cultures were positive, with primarily gram-negative (93%) pathogens. Staphylococcus aureus and Pseudomonas aeruginosa were documented as the most common pathogens, and no pneumonia cases were attributed to donors.

The results also revealed that pulmonary hypertension (hazard ratio [HR], 4.42) and pretransplant immunosuppression (HR, 2.87) were associated with pneumonia, and in the first month, patients with pneumonia had fewer ventilator-free (nine vs. 27), ICU-free (three vs. 24), and hospital-free days (zero vs. 10). Both hospital-acquired and ventilator-associated pneumonia contributed to more extended hospital stays (HR, 5.44), with ventilator-associated pneumonia also extending ICU stays (HR, 4.31). One nonpneumonia patient died within 30 days, and two more patients (one with and one without pneumonia) died within 90 days. The researchers noted no substantial variances between the two groups in 30- and 90-day mortality rates.

“Prospectively assessed early pneumonia incidence occurred in ∼10% of LT. Populations at increased risk for pneumonia occurrence include LT with pre-transplant pulmonary hypertension and pre-transplant immunosuppression. Pneumonia was associated with increased healthcare use, highlighting the need for further improvements by preferentially targeting higher-risk patients,” the authors concluded.

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