Description and Characterization of Intraoperative Bacterial Cultures During Lung Transplant Surgery

Abstract

<h3>Purpose</h3> Describe and characterize intraoperative bacterial cultures collected during lung transplant surgery. <h3>Methods</h3> This was a single-center retrospective chart review from 1/1/2018 through 5/31/2021. All adult patients undergoing lung transplant at Cedars Sinai Medical Center during the study period were included. No cystic fibrosis patients were transplanted during this time. Intraoperative cultures were collected by swabbing the bronchus. Given single and bilateral lung transplants were performed, a total of 84 patients yielded 116 cultures. The antibiotics utilized post-operatively were vancomycin and cefepime as per institutional protocol. Antibiotics were continued for at least 3 days until intraoperative cultures finalized. Further duration, consolidation, and/or de-escalation was based on clinical course and culture data. <h3>Results</h3> 56% (65/116) of cultures were positive for bacteria. Yearly breakdown yielded similar data: 53.3% (16/30) in 2018; 54.5% (12/22) in 2019; 66.7% (18/27) in 2020; 51.4% (19/37) in 2021. Forty-eight cultures had gram positive (GP) growth, with Staphylococcus being most common (42/48 of GP cultures). Methicillin-Resistant Staphylococcus Aureus (MRSA) accounted for 21.4% (9/42) of these cultures. Gram negative (GN) growth was seen in 38 cultures: Enterobacter (11/38), Klebsiella (10/38), Acinetobacter (7/38), Pseudomonas (4/38), Escherichia (2/38), Stenotrophomonas (1/38), Citrobacter (1/38), Neisseria (1/38), Haemophilus (1/38). <h3>Conclusion</h3> This culture data reinforces that broad spectrum antibiotics are warranted after lung transplant surgery. Given the high incidence of Staphylococcus, including MRSA, it is prudent to provide MRSA coverage until final culture data is available. Although Pseudomonas only accounted for 10.5% of GN cultures, this could be due to the patient population transplanted during the study period. Centers should continue to use their own culture data and population to guide antibiotic choice.