Pneumonia in the Early Post-Lung Transplant Period: A Prospective Study

Abstract

<h3>Purpose</h3> Hospital- (HAP) and Ventilator-associated pneumonia (VAP) are important complications early (<30 days) after lung transplantation (LT). However, current incidence, risk factors at LT and outcomes are not well reported. <h3>Methods</h3> We included all recipients who underwent LT 07/2019-02/2020 at our institution. We prospectively collected epidemiological and microbiological data in the first 30 days post-LT. We assessed incidence and presentation of HAP/VAP as per ISHLT criteria and evaluated the impact of pre specified risk factors using logistic regression models. As well as the impact of HAP/VAP on ICU and hospital length of stay. <h3>Results</h3> In the first 30 days post LT 9/119 (7.5%) recipients were diagnosed with at least one episode of HAP/VAP. VAP incidence rate was 9.6/1000 ventilator days (95% CI 5.0-18.1). Characteristics of recipients at LT are shown in Table 1A. Median time to HAP/VAP was 11 days (IQR 8-15), most episodes included gram negative pathogens 7/8 (88%). Associated pathogens were de novo acquisitions in 7/8 (88%) cases. Leukocytosis (5/9, 56%) and fever (2/9, 22%) were rare at diagnosis of HAP/VAP. Recurrence of HAP/VAP occurred in 2/9 (22%) cases during the first 30 days. Diabetes mellitus at baseline was the only risk factor associated with HAP/VAP post LT in the univariable analysis (p=0.025); Table 1B. In recipients with HAP/VAP vs. without, median ICU (18d [IQR 11-26] vs. 7d [IQR 6-8] p<0.001]) and hospital stay (29d [IQR 27-31] vs. 20d [IQR 18-22] <0.02) were longer. Among patients at risk for VAP (duration of mechanical ventilation (MV) >48h), median duration of MV was longer in recipients with VAP compared to those without (20d [IQR 11-28] vs. 8d [IQR 6-10] p<0.001). No death occurred in the first 30 days. <h3>Conclusion</h3> Prospectively assessed early HAP/VAP incidence was low in our cohort at 7.5%. Associated pathogens were mainly not donor- or recipient-derived but rather de novo acquisitions. HAP/VAP occurrence was associated with increased duration of ICU and hospital length of stay, without effect on 30-day mortality.