The effects of panresistant bacteria in cystic fibrosis patients on lung transplant outcome
The effects of panresistant bacteria in cystic fibrosis patients on lung transplant outcome
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DOI：
10.1164/ajrccm.155.5.9154879
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发表时间：
1997-05-01
影响因子：
24.7
通讯作者：
Yankaskas, JR
中科院分区：
文献类型：
--
作者：
Aris, RM;Gilligan, PH;Yankaskas, JR
随着长期生存率的提高，接受肺移植的囊性纤维化（CF）患者的数量继续上升。这种可能挽救生命的干预措施的一个主要禁忌症是感染多重耐药细菌。我们对66例6年以上的移植患者进行了回顾性研究，以确定泛耐药菌对移植结果的影响。术前和/或术中获得的呼吸道细菌的体外抗生素敏感性模式用于将患者分类为泛耐药组（n = 27）（洋葱伯克氏菌，n = 6，铜绿假单胞菌，n = 21）或敏感组（n = 39）。两组术后呼吸机使用天数、住院时间和抗生素使用天数相似（p > 0.2）。6个月时，两组间细菌性支气管炎（分别为28%和33%）和肺炎（分别为28%和38%）的发生率无差异（p > 0.2）。同样，两组的一年生存率（分别为81%和83%）相似（p > 0.2）。正如预期的那样，泛耐药B。洋葱病患者的1年生存率较低（50%与90%，p < 0.05），并且归因于B的死亡率较高。与泛耐药铜绿假单胞菌患者相比，洋葱炎（50%对0%，p < 0.01）。我们的研究结果表明，感染泛耐药铜绿假单胞菌的CF患者与敏感细菌患者具有相似的移植结局，不应仅基于此标准排除肺移植。
The number of cystic fibrosis (CF) patients undergoing lung transplant continues to rise as long term survival improves. One major contraindication to this potentially life-saving intervention is infection with multi-drug-resistant bacteria. We undertook this retrospective study in 66 transplanted patients over 6 yr to determine the influence of panresistant bacteria on transplant outcome. The in vitro antibiotic susceptibility pattern of respiratory tract bacteria obtained pre- and/or intraoperatively was used to categorize patients into panresistant (n = 27) (Burkholderio cepacia, n = 6, and Pseudomonas aeruginosa, n = 21) or sensitive (n = 39) groups. Postoperative ventilator days, hospital length of stay, and antibiotic days were similar for both groups (p > 0.2). The incidence of bacterial bronchitis (28% and 33%, respectively) and pneumonia (28% and 38%, respectively) did not differ between these groups (p > 0.2) at 6 mo. Likewise, one-year (81% and 83%, respectively) survival was similar for both groups (p > 0.2). As expected, panresistant B. cepacia patients had a lower l-yr survival (50% versus 90%, p < 0.05) and had a higher mortality attributable to B. cepacia (50% versus 0%, p < 0.01) compared with panresistant P. aeruginosa patients. Our results indicate that CF patients infected with panresistant P. aeruginoso have similar transplant outcomes as patients with sensitive bacteria and should not be excluded from lung transplant based solely on this criterion.