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Staphylococcus aureusinfections in the early period after lung transplantation: Epidemiology, risk factors, and outcomes

Authors
Publisher
Elsevier Inc.
Volume
31
Issue
11
Identifiers
DOI: 10.1016/j.healun.2012.08.012
Keywords
  • Staphylococcus Aureus
  • Mssa
  • Mrsa
  • Lung Transplant
  • Epidemiology
Disciplines
  • Biology
  • Medicine
  • Philosophy

Abstract

BACKGROUND Staphylococcus aureus infections among lung transplant recipients are poorly studied. METHODS We conducted a 5-year retrospective study of the epidemiology, clinical manifestations, risk factors, and outcomes of patients infected with S aureus within the first 90 days after lung transplantation. RESULTS An S aureus infection developed in 109 of 596 lung transplant (18%) recipients. Methicillin-susceptible S aureus (MSSA; 62%) was more common than methicillin-resistant S aureus (MRSA; 38%); however, the proportion of infections caused by MRSA increased over time. Pneumonia (48%) was the most common infection, followed by tracheobronchitis (26%), bacteremia (12%), intrathoracic infections (7%), and skin/soft tissue infections (7%). Risk factors included mechanical ventilation for >5 days and isolation of S aureus from recipients’ sterility cultures. Patients with MRSA cultured from the nares or respiratory tract at the time of transplant were at an increased risk for MRSA infection (p<0.0001 and p=0.02, respectively). Infected patients required longer hospital and intensive care unit stays (p<0.0001 for both), but the 30- and 90-day mortality rates from the onset of infection were only 7% and 12%, respectively. However, infected patients had higher rates of acute and chronic rejection at 1 (p=0.048) and 3 years (p=0.002), and higher rates of mortality at 1 (p=0.058) and 3 years (p=0.009). Conclusions S aureus infections within the first 90 days of lung transplant were associated with low short-term mortality but increased long-term rates of mortality and acute and chronic rejection. Future studies are needed to explore the utility of S aureus eradication strategies in reducing disease burden and improving outcomes.

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