1758. Epidemiology of Invasive Mycoplasma and Ureaplasma Infections Early after Lung Transplantation
1758. Epidemiology of Invasive Mycoplasma and Ureaplasma Infections Early after Lung Transplantation
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DOI：
10.1093/ofid/ofz360.1621
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发表时间：
2019-10-23
影响因子：
4.2
通讯作者：
Alexander BD
中科院分区：
文献类型：
--
作者：
Baker AW;Messina JA;Maziarz EK;Saullo J;Miller R;Miller R;Wolfe CR;Arif S;Reynolds JM;Perfect JR;Alexander BD
支原体和解脲支原体可导致肺移植后早期的侵袭性感染，这些感染很难诊断，并与大量发病率有关，包括高氨血症综合征。需要关于这些感染的流行病学和临床结果的数据，以便为捐赠者和接受者的临床管理和筛查方案提供信息。我们回顾收集了2010年1月1日至2019年4月15日在本院接受肺移植的所有患者的临床资料，随后对人型支原体或解脲支原体进行了阳性培养或聚合酶链式反应检测。仅来自生殖道的阳性结果的患者被排除在外。我们分析了供者和受者的临床特征、治疗过程和移植后长达2年的结果。在1055例肺移植受者中，20例(1.9%)患者发生侵袭性人型支原体或解脲支原体感染。人型支原体引起前10例感染(2010-2016)，解脲支原体。导致10例后续感染(2017-2019年)。首次阳性培养或聚合酶链式反应研究的时间中位数仅为移植后19天(范围为4-90天)。供者的平均年龄为31岁(范围18-45岁)，16例(80%)供者的胸部影像显示出与抽吸相适应的空隙病变。13名(65%)受者被确认为呼吸道外感染，包括8名人分枝杆菌脓胸患者(图1)。10名患者(50%)出现与感染有关的暂时性精神状态改变；这些患者中有8名(80%)血氨水平升高，包括3名人型支原体感染患者。中位治疗时间为6周(IQR，4-9周)，包括几乎所有患者的联合抗菌方案。术后其他并发症也很常见，11例(55%)患者在移植后1年内死亡(中位数为117天；IQR为65-255天)(图2)。解脲支原体和人型支原体感染发生在肺移植后早期，并与相当大的发病率和死亡率有关。移植临床医生对这些微生物进行特定的诊断测试应该有较低的门槛。需要制定捐赠者和接受者筛选和管理的协议。雷切尔·米勒，医学博士，Synexis：研究补助金。
Mycoplasma and Ureaplasma species can cause invasive infections early after lung transplant that are difficult to diagnose and associated with substantial morbidity, including hyperammonemia syndrome. Data on the epidemiology and clinical outcomes of these infections are needed to inform clinical management and screening protocols for donors and recipients. We retrospectively collected clinical data on all patients who underwent lung transplantation at our hospital from January 1, 2010 to April 15, 2019 and subsequently had positive cultures or PCR studies for M. hominis or Ureaplasma spp. Patients with positive studies from only the genitourinary tract were excluded. We analyzed donor and recipient clinical characteristics, treatment courses, and outcomes for up to 2 years after transplant. Of 1055 total lung transplant recipients, 20 (1.9%) patients developed invasive infection with M. hominis or Ureaplasma spp. M. hominis caused the first 10 infections (2010–2016), and Ureaplasma spp. caused 10 subsequent infections (2017–2019). Date of first positive culture or PCR study occurred a median of only 19 days after transplant (range, 4–90 days). Median donor age was 31 years (range, 18–45 years), and chest imaging for 16 (80%) donors revealed airspace disease compatible with aspiration. Infection outside of the respiratory tract was confirmed for 13 (65%) recipients, including 8 patients with M. hominis empyemas (Figure 1). Ten (50%) patients developed altered mental status that was temporally associated with infection; 8 (80%) of these patients had elevated serum ammonia levels, including 3 patients with M. hominis infection. Median duration of therapy was 6 weeks (IQR, 4–9 weeks), consisting of combination antimicrobial regimens for nearly all patients. Additional postoperative complications were common, and 11 (55%) patients died within 1 year after transplant (median, 117 days; IQR, 65–255 days) (Figure 2). Ureaplasma and M. hominis infections occurred early after lung transplant and were associated with substantial morbidity and mortality. Transplant clinicians should have low thresholds for performing specific diagnostic testing for these organisms. Protocols for donor and recipient screening and management need to be developed. Rachel Miller, MD, Synexis: Research Grant.