Gram-negative bacterial colonizations before bilateral lung transplant. The impact of 'targeted' versus 'standard' surgical prophylaxis

• Published in: BMC infectious diseases 2024-03, Vol.24 (1), p.307-307, Article 307
• Main Authors: Congedi, Sabrina, Peralta, Arianna, Muraro, Luisa, Biscaro, Martina, Pettenuzzo, Tommaso, Sella, Nicolò, Crociani, Silvia, Tagne, Arméla Anne-Sabine, Caregnato, Ida, Monteleone, Francesco, Rossi, Elisa, Roca, Gabriella, Manfrin, Silvia, Marinello, Serena, Mazzitelli, Maria, Dell'Amore, Andrea, Cattelan, Annamaria, Rea, Federico, Navalesi, Paolo, Boscolo, Annalisa
• Format: Article
• Language: English
• Subjects: Analysis; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Antimicrobial stewardship; Bacteria; Bacterial infections; Bilateral lung transplant; Care and treatment; Complications and side effects; Disease prevention; Drug resistance; Drug resistance in microorganisms; Electronic health records; Extracorporeal membrane oxygenation; Gram-Negative Bacteria; Gram-negative bacterial infections; Gram-Negative Bacterial Infections - drug therapy; Health aspects; Hospitals; Humans; Infections; Lung transplant; Lung transplantation; Lung Transplantation - adverse effects; Lungs; Mortality; Multidrug resistance; Ostomy; Patients; Pneumonia; Postoperative Complications - drug therapy; Postoperative Complications - prevention & control; Prevention; Prophylaxis; Retrospective Studies; Risk factors; Sepsis; Software; Surgery; Surgical prophylaxis; Surveillance; Tazobactam; Transplant Recipients; Transplantation; Transplantation of organs, tissues, etc; Transplants & implants; Ventilators
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-024-09199-y

Infections are one of the most common causes of death after lung transplant (LT). However, the benefit of 'targeted' prophylaxis in LT recipients pre-colonized by Gram-negative (GN) bacteria is still unclear. All consecutive bilateral LT recipients admitted to the Intensive Care Unit of the University Hospital of Padua (February 2016-2023) were retrospectively screened. Only patients with pre-existing GN bacterial isolations were enrolled and analyzed according to the antimicrobial surgical prophylaxis ('standard' vs. 'targeted' on the preoperative bacterial isolation). One hundred eighty-one LT recipients were screened, 46 enrolled. Twenty-two (48%) recipients were exposed to 'targeted' prophylaxis, while 24 (52%) to 'standard' prophylaxis. Overall prevalence of postoperative multi-drug resistant (MDR) GN bacteria isolation was 65%, with no differences between the two surgical prophylaxis (p = 0.364). Eleven (79%) patients treated with 'standard' prophylaxis and twelve (75%) with 'targeted' therapy reconfirmed the preoperative GN pathogen (p = 0.999). The prevalence of postoperative infections due to MDR GN bacteria was 50%. Of these recipients, 4 belonged to the 'standard' and 11 to the 'targeted' prophylaxis (p = 0.027). The administration of a 'targeted' prophylaxis in LT pre-colonized recipients seemed not to prevent the occurrence of postoperative MDR GN infections.