Abstract
Achromobacter is an opportunistic pathogen that mainly causes chronic lung infections in cystic fibrosis (CF) patients and is associated with increased mortality. Little is known about Achromobacter spp. in the lung transplant recipient (LTXr) population. We aimed at describing rates of Achromobacter spp. infection in LTXr prior to, in relation to, and after transplantation, as well as all-cause mortality proportion in infected and uninfected LTXr. We included 288 adult LTXr who underwent lung transplantation (LTX) between 1 January 2010 and 31 December 2019 in Denmark. Bronchoalveolar lavage was performed at regular intervals starting two weeks after transplantation. Positive cultures of Achromobacter spp. were identified in nationwide microbiology registries, and infections were categorized as persistent or transient, according to the proportion of positive cultures. A total of 11 of the 288 LTXr had transient (n = 7) or persistent (n = 4) Achromobacter spp. infection after LTX; CF was the underlying disease in 9 out of 11 LTXr. Three out of the four patients, with persistent infection after LTX, also had persistent infection before LTX. The cumulative incidence of the first episode of infection one year after LTX was 3.8% (95% CI: 1.6–6.0). The incidence rates of transient and persistent infection in the first year after LTX were 27 (12–53) and 15 (5–37) per 1000 person-years of follow-up, respectively. The all-cause mortality proportion one year after LTX was 27% in the Achromobacter spp. infected patients and 12% in the uninfected patients (p = 0.114). Achromobacter spp. mainly affected LTXr with CF as the underlying disease and was rare in non-CF LTXr. Larger studies are needed to assess long-term outcomes of Achromobacter spp. in LTXr.
Highlights
Achromobacter is a genus of non-fermentative aerobic Gram-negative rods, mainly found in the environment in water and soil
There is no standard treatment protocol [7], it has been suggested that early treatment with inhaled and oral antibiotics postpones time to the culture of Achromobacter spp. in cystic fibrosis (CF) patients [8]
The median age at transplantation was significantly lower in LTXr with Achromobacter spp. infection compared to the uninfected group (33 vs. 53 years, p = 0.006)
Summary
Achromobacter is a genus of non-fermentative aerobic Gram-negative rods, mainly found in the environment in water and soil. Opportunistic disease in humans is well described and typically manifests as chronic respiratory infections in persons with chronic lung disease, such as cystic fibrosis (CF) or in immunocompromised patients [1,2,3,4]. Extra-pulmonary manifestations such as sepsis, bacteremia, urine-, and catheter or device infections are seen [1,3,5,6]. Infections with Achromobacter spp. are difficult to treat because of intrinsic and acquired antibiotic resistance. There is no standard treatment protocol [7], it has been suggested that early treatment with inhaled and oral antibiotics postpones time to the culture of Achromobacter spp. in CF patients [8]
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