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Background: 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., Methods: 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)., Results: 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)., Conclusions: The administration of a 'targeted' prophylaxis in LT pre-colonized recipients seemed not to prevent the occurrence of postoperative MDR GN infections., (© 2024. The Author(s).)

Background: In recent decades, the incidence of multidrug-resistant (MDR) and extended-spectrum β-lactamase (ESBL) gram-negative (GN) bacteria has increased progressively among lung transplantation (LT) recipients. A prompt diagnosis, prevention, and management of these pathogens remain the cornerstone for successful organ transplantation., Research Question: What are the incidence of MDR and ESBL GN bacteria within the first 30 days after LT and related risk of in-hospital mortality? What are the potential clinical predictors of isolation of MDR and ESBL GN bacteria?, Study Design and Methods: All consecutive LT recipients admitted to the ICU of the University Hospital of Padua (February 2016-December 2021) were screened retrospectively. Only adult patients undergoing the first bilateral LT and not requiring invasive mechanical ventilation, extracorporeal membrane oxygenation, or both before surgery were included. MDR and ESBL GN bacteria were identified using in vitro susceptibility tests and were isolated from the respiratory tract, blood, urine, rectal swab, or surgical wound or drainage according to a routine protocol., Results: One hundred fifty-three LT recipients were screened, and 132 were considered for analysis. Median age was 52 years (interquartile range, 41-60 years) and 46 patients (35%) were women. MDR and ESBL GN bacteria were identified in 45 patients (34%), and 60% of patients demonstrated clinically relevant infection. Pseudomonas aeruginosa (n = 22 [49%]) and Klebsiella pneumoniae (n = 17 [38%]) were frequently isolated after LT from the respiratory tract (n = 21 [47%]) and multiple sites (n = 18 [40%]). Previous recipient-related colonization (hazard ratio [HR], 2.48 [95% CI, 1.04-5.90]; P = .04) and empirical exposure to broad-spectrum antibiotics (HR, 6.94 [95% CI, 2.93-16.46]; P < .01) were independent predictors of isolation of MDR and ESBL GN bacteria. In-hospital mortality of the MDR and ESBL group was 27% (HR, 6.38 [95% CI, 1.98-20.63]; P < .01)., Interpretation: The incidence of MDR and ESBL GN bacteria after LT was 34%, and in-hospital mortality was six times greater. Previous recipient-related colonization and empirical exposure to broad-spectrum antibiotics were clinical predictors of isolation of MDR and ESBL GN bacteria., (Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Malnutrition and sarcopenia have been widely reported to negatively influence patients' outcomes in different clinical settings, but information is lacking about their impact on short and long-term outcomes after lung transplantation (LT). The aim of this study was to investigate which nutritional and sarcopenia indices independently predict prolonged post-operative invasive mechanical ventilation (IMV), intensive care unit (ICU) and hospital length of stay (LOS), re-intubation and rejection after LT. Observational, retrospective study on patients undergoing LT in a single University Hospital was conducted between February 2016 and November 2020. Within 6 months before LT, the following data were collected: a) nutritional indices (Body Mass Index (BMI), serum albumin concentration, Prognostic Nutritional Index (PNI), Mini Nutritional Assessment Short-Form (MNA-SF)); b) sarcopenia indices (Creatinine Height Index (CHI), Skeletal Muscle Index (SMI) and densitometry of paravertebral muscles at chest CT-scan); c) postoperative clinical data related to the outcomes of interest. Univariable logistic regression models were used for binary outcomes and univariable gamma models for continuous outcomes. 108 of 114 patients were enrolled after excluding 6 patients for incomplete records. Seventy-two patients (67%) were male, median age was 52 [43-60] years. The main indications for BLT were interstitial (46%), septic (22%) and obstructive (19%) diseases. The IMV duration was non-linearly associated with pre-operative serum albumin (range 30-35 g/L: effect -1.67 [-2.45 - -0.89] hours, p<0.01). The ICU LOS was non-linearly correlated to albumin (range 30-35 g/L: effect -0.84 [-1.23 - -0.45] days, p<0.01) and PNI (range 25-40: effect -1.79 [-3.09 - -0.50] days, p=0.01), but linearly associated to BMI (range 20.7-27.4 kg/m2: effect +0.34 [0.03 - 0.68] days, p=0.04). No nutritional or muscle parameters predicted the need for re-intubation, the presence of rejection at 30 days and hospital LOS. Pre-operative low serum albumin independently predicts prolonged IMV after LT, while pre-transplant low albumin, low PNI and high BMI values are associated with prolonged postoperative ICU LOS. Further studies are needed to identify the most appropriate nutritional and muscular assessment tools in BLT recipients. [ABSTRACT FROM AUTHOR]