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Introduction La transplantation pulmonaire (TP) est la seule option therapeutique des maladies pulmonaires parenchymateuses echappant aux traitements medicamenteux. Les infections pulmonaires, complications frequentes avec un pic d’incidence au cours du mois suivant la TP [1] , sont associees a une morbi-mortalite importante. Afin d’optimiser l’antibiotherapie probabiliste, il est important de bien connaitre les profils de resistance des bacteries responsables de ces infections. Le but de l’etude etait de decrire la frequence d’emergence des bacteries multi-resistantes (BMR) retrouvee sur les prelevements respiratoires au cours du premier mois suivant la TP et leurs facteurs de risque. Materiel et methodes Cette etude retrospective mono-centrique analyse 176 patients (pts) adultes ayant eu une TP sur une periode de 6 ans. Les donnees microbiologiques recoltees proviennent des prelevements respiratoires realises en reanimation au cours des 30 premiers jours (j) suivant la TP. Les BMR sont identifiees selon les recommandations internationales [2] . Les analyses statistiques sont realisees avec le test de Mann-Whitney, le Chi 2 et un modele de regression logistique. Resultats Sur les 1176 bacteries isolees, 404 (34 %) etaient des BMR retrouvees chez 90 pts (51 %) [principalement Pseudomonas aeruginosa (20 % des BMR), Enterobacter spp (19 %), Staphylococcus aureus (11 %) et Stenotrophomonas maltophilia (10 %)]. Les BMR ont emerge en mediane a j9 apres TP. Une correlation etait observee entre le temps depuis la TP et l’emergence des BMR ( r 2 : 0,59 ; p p = 0,0009), la presence d’une tracheotomie (OR : 3,28 [1,05–10,28] ; p = 0,039) et l’utilisation prealable d’un antibiotique a large spectre (OR : 2,25 [1,17–4,34] ; p = 0,016) etaient des facteurs de risque d’emergence de BMR. La sensibilite aux differents antibiotiques decroissait rapidement. La sensibilite globale au cefepime (FEP) diminuait de 81 % a 50 % pour tous les germes identifies entre la 1 e et la 4 e semaine d’hospitalisation en reanimation, la sensibilite a l’imipeneme (IPM) passait de 90 % a 48 %, celle de l’amikacine (AMK) de 85 % a 64 %, celle de la piperacilline–tazobactam (TZP) de 77 % a 50 % ( Fig. 1 ). Discussion Chez nos pts transplantes pulmonaires, une large proportion de BMR a emerge dans un delai median de 9 j. La duree d’hospitalisation en reanimation et la presence d’une antibiotherapie anterieure a large spectre etaient les principaux determinants de cette emergence. Au vu de ces resultats et pour un traitement adapte, une antibiotherapie a large spectre semble necessaire des la phase precoce.

Purpose Postoperative infectious complications are key issues following lung transplantation (LT). Fungal bronchial colonization (FBC) is reported in 40 to 80% of the cases and is usually considered as a complication. The risk factors, morbidity and mortality linked to FBC were assessed in a retrospective monocentric cohort of LT. Methods and Materials From 2006 to 2010, all consecutive LT performed in our institution were included. Demographic and microbiologic data during the first 30 postoperative days after LT were collected. The risk factors of developing FBC and its prognosis were assessed. Results Among 102 LT (emphysema 46%, idiopathic fibrosis 38%), FBC was reported after LT in 52% of the cases in a median delay of 3 [2-5 IQ] days after LT. Only one donor was colonized while 11 % of the recipients were colonized before LT. The main organisms involved in FBC were Candidas (78% of the cases, C albicans (54%), other Candidas species (24%)) while Aspergillus were reported in 9% of the cases. The risk factors associated with FBC are presented in the table 1 . Ischemic bronchitis was reported in 24% of the cases and all of them developed FBC. 75% of FBC were treated by antifungal therapy. Interestingly FBC did not have any impact on length of mechanical ventilation and mortality at day 30. Conclusions FBC is a frequent situation, especially in double LT. The links between ischemic bronchitis and FBC are not clear. FBC in these cases could be a consequence rather than a cause. In patients with identified risk factors (double LT, colonization of conservation liquid), a preemptive antifungal therapy could be discussed. Factors associated with fungal colonization Parameters Odds Ratio 95% IC p Double lung transplantation 3.93 1.49-10.40 0.0037 Hospitalisation >10 days 2.75 1.12-6.77 0.0214 ischemic bronchitis 10.06 2.77-36.66 0.0001 conservation liquid colonization 8.66 0.98-76.11 0.028

Purpose Postoperative infectious complications are key issues following lung transplantation (LT). Early bacterial pneumonia (EBP) worsen prognosis of LT. Assessment of bacterial epidemiology of EBP is necessary to optimize treatment of EBP, thus improving LT outcome. Methods and Materials From 2006 to 2010, all consecutive LT performed in our institution were included. Demographic and microbiologic data during the first 30 postoperative days after LT were collected. Results 102 LT (emphysema 46%, idiopathic fibrosis 38%) were performed during the study period. Among 831 bacteriological cultures of bronchial aspirate, 307 were positive. Evolution of bacterial epidemiology during the first 2 weeks is presented in figure 1 . Donor colonization was associated with recipient infection with Methicilin-sensitive Staphylococcus aureus (MSSA) (OR=5,84; [1,87-18,27], p=0,0033) and Enterobacteria (0R=2,8; [1,15-6,83], p=0,037). Presence of purulent expectoration, contrary to fever, leukocyte count, chest X ray, impairment in lung function and CPIS scor, was associated with positive bacterial cultures (OR=1,99; IC [1,45-2,72] p=0,01). Interestingly, type of bacteria did not have any impact on mortality at day 30. Conclusions There is an evolution of bronchial bacterial epidemiology during the 2 weeks following LT with an increase in Pseudomonas aeruginosa proportion. Only purulent expectoration, but not other parameters currently used to diagnose post operative pneumonia, is associated with positive bacterial culture of bronchial aspiration. These findings highlight the challenging problems raised by the diagnosis of respiratory infection after LT.