Bronchopulmonary Infections Research Articles

Parenteral MCT/ω-3 Polyunsaturated Fatty Acid-Enriched Intravenous Fat Emulsion Is Associated With Cytokine and Fatty Acid Profiles Consistent With Attenuated Inflammatory Response in Preterm Neonates: A Randomized, Double-Blind Clinical Trial.

Soybean oil-based intravenous fat emulsion (IVFE) administered to preterm neonates can induce oxidative stress and inflammatory response, which are associated with severe complications of prematurity. This study aimed to test the hypothesis that administration of medium-chain triglyceride (MCT)/ω-3 polyunsaturated fatty acid (PUFA)-enriched IVFE in preterm neonates is associated with a cytokine and fatty acid (FA) profile consistent with attenuated inflammatory response. In a double-blind randomized study, 60 preterm neonates (gestational age 26-32 weeks) were randomized to receive either MCT/ω-3 PUFA-enriched IVFE (intervention group) or soybean oil-based IVFE (control group). Serum biochemistry, tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8, α-tocopherol, and FAs were assessed at baseline, on day of life 15, and day of life 30 or at the end of intervention. All cytokine levels changed significantly across the 3 time points, whereas the type of IVFE had a significant effect on final IL-6 and IL-8 levels, which were lower in the intervention group. The difference in final IL-6 and IL-8 levels remained significant after controlling for bronchopulmonary dysplasia and/or infection. α-Tocopherol and FA values changed significantly over time. MCT/ω-3 PUFA-enriched IVFE administration was associated with significantly higher α-tocopherol, eicosapentaenoic acid, docosahexaenoic acid, and ω-3 PUFAs and lower linolenic acid, total PUFA, and ω-6/ω-3 PUFA values compared with soybean oil-based IVFE. Both IVFEs were well tolerated. Compared with the soybean oil-based IVFE, the MCT/ω-3 PUFA-enriched IVFE is associated with a more favorable cytokine and FA profile consistent with attenuated inflammatory response in preterm neonates.

Swallowing disorders in severe brain injury in the arousal stage

Swallowing disorders are frequent after acquired brain injury and could be at risk of severe impairments, especially aspiration pneumonia. To determine the clinical characteristics of swallowing disorders after severe brain injury in the arousal stage after coma. The patients were included prospectively and consecutively, between December 1st 2013 and June 30th2014 for rehabilitation after a severe acquired brain injury, which motivated an admission in intensive care unit. Patients didn’t report swallowing disorders before the recent brain injury. Socio-demographic data and initial general clinics were collected. The evaluation of swallowing included an oriented clinical examination, a functional swallowing test, and a nasofibroscopy with per endoscopic swallowing test. The possibility of oral feeding and the occurrence of complications related to swallowing disorders (weight loss or bronchopulmonary infection) were collected. Of the 13 patients admitted, 11 were included and 9 (81.8%) were male. The mean age was 40.7 ± 14.6 years. All patients had swallowing disorders at admission. The first functional swallowing test showed a disorder of transport of the food bolus whether oral (77.8%) and pharyngeal (66.7%) leading with the compote consistency, while alterations of airways protective mechanisms predominated with the sparkling fluid consistency (80% of tested patients). The swallowing test under endoscopic control highlighted, regardless of consistency, a disorder of the coordination of swallowing, mostly importantly, in 55.6% of patients tested. Seven (63.6%) of patients resumed oral feeding within an average of 6 weeks after admission and 14 weeks after acquired brain injury, with continued need for solid and liquid textures suitable for 6 (85.7%) of them. It did not occur complications related to swallowing disorders during the study. Swallowing disorders are systematic in severe brain injury in the arousal stage. Early bedside assessment of swallowing is essential to detect and propose a rehabilitative medical care appropriate to these patients in a state of altered consciousness.

Preliminary discussion about hypermastigote bronchopulmonary infection of children

The children with pulmonary hypermastigote infection, has not been reported at home and abroad.In recent years, we have carried out the children's electronic bronchoscopy, bronchoalveolar lavage fluid routine smear examination, found a lively movement round or oval body-hypermastigote.Metronidazole treatment is effective in controlling the disease.After discovery, understanding, rediscovery, reunderstanding, now have a preliminary understanding of the disease, first reported as follows. Key words: Hypermastigotes; Bronchopulmonary infection; Child; Metronidazole

In antisynthetase syndrome, ACPA are associated with severe and erosive arthritis: an overlapping rheumatoid arthritis and antisynthetase syndrome.

Anticitrullinated peptide/protein antibodies (ACPA), which are highly specific for rheumatoid arthritis (RA), may be found in some patients with other systemic autoimmune diseases. The clinical significance of ACPA in patients with antisynthetase syndrome (ASS), a systemic disease characterized by the association of myositis, interstitial lung disease, polyarthralgia, and/or polyarthritis, has not yet been evaluated with regard to phenotype, prognosis, and response to treatment. ACPA-positive ASS patients were first identified among a French multicenter registry of patients with ASS. Additionally, all French rheumatology and internal medicine practitioners registered on the Club Rhumatismes et Inflammation web site were asked to report their observations of ASS patients with ACPA. The 17 collected patients were retrospectively studied using a standardized questionnaire and compared with 34 unselected ACPA-negative ASS patients in a case–control study. All ACPA-positive ASS patients suffered from arthritis versus 41% in the control group (P < 0.0001). The number of swollen joints was significantly higher (7.0 ± 5.0 vs 2.9 ± 3.9, P < 0.005), with a distribution resembling that of RA. Radiographic damages were also more frequent in ACPA-positive ASS patients (87% vs 11%, P < 0.0001). Aside from a significantly higher transfer factor for carbon monoxide in ACPA–ASS patients, lung, muscle, and skin involvements had similar incidences, patterns, and severity in both groups. Although Nonbiologic treatments were similarly used in both groups, ACPA-positive patients received biologics more frequently (59% vs 12%, P < 0.0008), mostly due to refractory arthritis (n = 9). Eight patients received anti-Cluster of differentiation 20 (CD20) monoclonal antibodies (mAbs) with good efficacy and tolerance, whereas 2 of the 5 patients treated with antitumor necrosis factor drugs had worsened myositis and/or interstitial lung disease. After a >7-year mean follow-up, extra-articular outcomes and survival were not different. ACPA-positive ASS patients showed an overlapping RA–ASS syndrome, were at high risk of refractory erosive arthritis, and might experience ASS flare when treated with antitumor necrosis factor drugs. In contrast, other biologics such as anti-CD20 mAb were effective in this context, without worsening systemic involvements.

Problèmes respiratoires des personnes polyhandicapées : le point de vue du médecin de médecine physique et de réadaptation

People with severe disability have a very vulnerable respiratory condition due to many reasons, namely a defect in the development of the lungs, neurological disorders of the respiratory command, narrowness and rigidity of the ribcage, scoliosis, an ineffective cough and so on. Added digestive problems hamper the respiratory system, such as swallowing the wrong way, having gastroesophageal reflux, going through bronchopulmonary secondary infections and suffering from transit disorders. These disorders contribute to worsening – in a general and insidious way – the general health. This impact increases when there is a defect in corpulence and when fragility is higher during critical periods, for instance during a surgery program fixing the hip or the rachis. The pediatric and reeducation team must know the respiratory risks for people suffering from severe disability in order to set up the right precautionary and therapeutic measures without limitation nor doggedness to improve their condition.

Mycotic Infections in Bronchopulmonary Diseases

Background: Recently pulmonary mycotic infections have gained increasing recognition in the field of infectious diseases and pose a difficult challenge.Since clinicians now see an increasing number of immuno-compromised patients, high index of suspicion is necessary for timely diagnosis and treatment of mycotic infections. Aim: The study was designed to document the prevalence and sensitivity pattern of fungal pathogens associated with bronchopulmonary infections. Material & Methods: The study includes 60 clinically diagnosed cases of bronchopulmonary infections along with 20 normal healthy individuals taken as control. Samples collected from cases and controls were processed to examine the presence of fungal pathogens and their sensitivity pattern was studied. Results: 40 fungal pathogens were isolated. Majority male patients (70%) were affected, among them(50%) belong to the age group of (41-60 years). Among the isolated fungal pathogens Candida spp predominated(40%) followed by Aspergillus spp (32.5%).One spp of Penicillium marneffei was isolated from an HIV sero positive patient. Two non albicans Candida spp were isolated from controlgroup. Among the antifungals used all the isolates were resistant to Trimethoprim (Tr),Co-trimazine(Cm),Co-trimoxazole(Co) and Polymyxin-B(Pb). All spp of Candida, Aspergillus and Penicillium were found to be sensitive to Clotrimazole(Cc).But Fusarium and Mucor spp were resistant to all the antifungal agents used. Conclusion: Hence a great awareness is required for selective isolation and identification of fungi along with their antifungal susceptibility pattern.

Genetic and Phenotypic Characteristics of Staphylococcus aureus Isolates from Cystic Fibrosis Patients in Austria

Background: Cystic fibrosis (CF) is the most common life-limiting inherited disease in Caucasian populations. While pathological changes can be seen in various organs, morbidity and mortality are mainly related to the respiratory tract, with patients suffering from chronic bronchopulmonary infections with characteristic pathogens including Staphylococcus aureus.Objectives: To date, there is only very limited data on the genetic and phenotypic characteristics of S. aureus in CF patients. Therefore, in our study, we characterized 58 S. aureus isolates collected from CF patients in Austria by spa typing, DNA microarray profiling, as well as antimicrobial susceptibility testing in order to determine common genomic and antimicrobial resistance features. The tested strain collection exhibited high genomic diversity. Results: The 58 isolates were assigned to 16 clonal complexes and 48 spa types and differed greatly regarding their virulence and resistance gene profiles. The predominant clonal complexes were MLST CC30 (22%), CC15 (16%), CC45 (14%), and CC5 (12%), complexes that are highly prevalent worldwide among S. aureus strains isolated from humans colonized or infected with S. aureus. DNA microarray profiles showed a wide variety of genes encoding antimicrobial resistance and virulence factors such as various leukocidins, haemolysins, enterotoxins, exfoliative toxins, toxic shock syndrome toxin, as well as genes involved in adhesion and immune evasion. Conclusions: While a large number of strains exhibited resistance to one or several antimicrobial agents, methicillin-resistant S. aureus was found at a low prevalence of 3% (n = 2) only. The two methicillin-resistant S. aureus isolates were assigned to CC152/t355 (SCCmecV) and CC5/t001 (SCCmecI). This is the first study to genetically characterize S. aureus isolates in CF patients in Austria.

Spanish Consensus on the Prevention and Treatment of Pseudomonas aeruginosa Bronchial Infections in Cystic Fibrosis Patients

Pseudomonas aeruginosa is the main pathogen in bronchopulmonary infections in cystic fibrosis (CF) patients. It can only be eradicated at early infection stages while reduction of its bacterial load is the therapeutic goal during chronic infection or exacerbations. Neonatal screening and pharmacokinetic/pharmacodynamic knowledge have modified the management of CF-patient. A culture based microbiological follow-up should be performed in patients with no infection with P. aeruginosa. At initial infection, inhaled colistin (0.5–2MU/tid), tobramycin (300mg/bid) or aztreonam (75mg/tid) with or without oral ciprofloxacin (15–20mg/kg/bid, 2–3weeks) are recommended. In chronic infections, treatment is based on continuous administration of colistin or with a 28-day on–off regimen with tobramycin or aztreonam. During mild-moderate exacerbations oral ciprofloxacin (2–3weeks) can be administered while serious exacerbations must be treated with intravenous combination therapy (beta-lactam with an aminoglycoside or a fluoroquinolone). Future studies will support rotation and/or new combination therapies. Epidemiological measures are also recommended to avoid new P. aeruginosa infections and cross transmission of this pathogen.

Consenso español para la prevención y el tratamiento de la infección bronquial por Pseudomonas aeruginosa en el paciente con fibrosis quística

Pseudomonas aeruginosa is the main pathogen in bronchopulmonary infections in cystic fibrosis (CF) patients. It can only be eradicated at early infection stages while reduction of its bacterial load is the therapeutic goal during chronic infection or exacerbations. Neonatal screening and pharmacokinetic/pharmacodynamic knowledge has modified the management of CF-patients. A culture based microbiological follow-up should be performed in patients with no infection with P.aeruginosa. At initial infection, inhaled colistin (0,5-2MU/tid), tobramycin (300mg/bid) or aztreonam (75mg/tid) with or without oral ciprofloxacin (15-20mg/kg/bid, 2-3weeks) are recommended. In chronic infections, treatment is based on continuous administration of colistin or with a 28-day on-off regimen with tobramycin or aztreonam. During mild-moderate exacerbations oral ciprofloxacin (2-3weeks) can be administered while serious exacerbations must be treated with intravenous combination therapy (beta-lactam with an aminoglycoside or a fluoroquinolone). Future studies will support antibiotic rotation and/or new combination therapies. Epidemiological measures are also recommended to avoid new P.aeruginosa infections and “patient-to-patient transmission” of this pathogen.

Pulmonary paecilomycosis: Diagnosis and treatment

To represent the advances of Russia and Uzbekistan in studying the problem of paecilomycosis. The goal of the investigation was to develop the diagnosis and treatment of pulmonary paecilomycosis (PP). Two hundred and twenty-five people, including 200 patients with bronchopulmonary infection with fungi of the Paecilomyces genus and 25 clinically healthy individuals (a control group), were examined. Clinico-anamnestic, laboratory diagnostic, mycological, and immunological studies were conducted; a lymphocyte antigen-binding test was used for differential diagnosis. Paecilomyces infection was diagnosed by microscopically examining the morphology of the fungi in the pathological material (blood, sputum) and by isolating the cultured fungi in the media (Sabouraud's and Czapek's ones). The severe complication of PP - atypical paecilomycosis-associated myocarditis (APAM) - was studied in 112 patients with helminthiasis-complicated paecilomycosis. These patients underwent using the conventional echocardiography. Bronchopulmonary paecilomycosis resulting from primary and secondary infection with fungi of the Paecilomyces genus was clinically manifested as chronic obstructive bronchitis (11.5%), recurrent pneumonia (13.5%), exogenous allergic alveolitis (37%), and asthma (26%) complicated by helminthiasis (12%). Iodine deficiency promotes the prevalence of paecilomycosis and echinococcosis favors Paecilomycosis infection; moreover, the helminth capsule itself serves as a nutrient medium for the development of the mycelial form of the fungus. APAM is a severe complication of PP. Almost 50% of the patients with PP presented with carditis. The patients with APAM occasionally experienced fear and the most severe intermittent pain. The latter first occurred in the chest.and irradiated to the axilla, left hand, and its fingertips, paralyzing the arm. In some patients, the pain manifested itself in both arms with abdominal irradiation, by being accompanied by faints. Current analgesics (meloxicam, tizanidine, nimesulide, morphine, promedole) in combination with fluconazole provided a temporary positive effect. Further investigations that must also include neurologists and anesthetists are required to work out effective pain relief regimens for APAM in patients with PP.

Cystic Lung Lesions in Newborns and Young Children: Differential Considerations and Imaging

Numerous diverse entities produce cystic lung changes in neonates and young children. This review provides an evidence-based, age-appropriate, differential diagnostic framework to use when confronted with pulmonary cystic changes. The categories of diseases that have been discussed include congenital cystic bronchopulmonary malformations, neoplastic conditions, infections, collagen or soft tissue abnormalities, and mimics of cystic lung disease. An understanding of the pathophysiology, imaging appearance, and demographics of these entities is essential in guiding optimal care. Important educational points include differentiating bronchopulmonary malformations from neoplasms and the management and surveillance of lung cysts in young children.

Occurrence of B-cell lymphomas in patients with activated phosphoinositide 3-kinase δ syndrome

Occurrence of B-cell lymphomas in patients with activated phosphoinositide 3-kinase δ syndrome

Factors That Correlate With the Decision to Delay Extubation After Multilevel Prone Spine Surgery

Multilevel spinal decompressions and fusions often require long anesthetic and operative times, which may result in airway edema and prolonged postoperative intubation. Delayed extubation can lead to bronchopulmonary infections and other complications. This study analyzed which factors correlated with the decision to delay extubation after multilevel spine surgery. We reviewed the records of 289 patients who underwent multilevel spine surgery lasting ≥8 hours in the prone position from 2006 to 2012. Variables hypothesized to affect the decision of the anesthesiologist to delay extubation at the end of the surgery were collected. These included preoperative factors (age, sex, ASA class, history of obstructive sleep apnea, BMI, previous spine surgery, current cervical surgery, anterior in addition to posterior spine surgery, emergency surgery) and intraoperative factors (difficult intubation, number of surgical levels, case time, estimated blood loss, fluid and blood administration, attending handoff and resident handoff, and case end time). We also compared the incidence of pulmonary postoperative complications between patients extubated at the end of the case to patients who had a delayed extubation. A total of 126 patients (44%) were kept intubated after multilevel spine surgery. Multiple linear regression analysis showed factors that correlated with prolonged intubation which included age, ASA class, procedure duration, extent of surgery, total crystalloid volume administered, total blood volume administered, and the case end time. Patients who had a delayed extubation had a 3-fold higher rate of postoperative pneumonia. Our study found that age, ASA class, procedure duration, extent of surgery, and total crystalloid and blood volume administered correlate with the decision to delay extubation in multilevel prone spine surgery. It also finds that the time the case ends is an independent variable that correlates with the decision not to extubate at the end of a long multilevel spinal surgery. The incidence of postoperative pneumonia is higher in patients who had a delayed extubation after surgery.

Esophageal atresia: a critical review of management at a single center in Algeria

The purpose was to study the outcomes and factors affecting the survival of esophageal atresia in our center. A retrospective analysis of 86 cases of esophageal atresia (EA) over a 10-year period was performed with 46 boys and 42 girls. Demographic data, birth weight, gestational age, consanguinity, incidence of associated anomalies, place of delivery, history of feeding, and outcomes were studied. EA with distal tracheoesophageal fistula (TEF) was the commonest type with 58/86 (67%). The percentage of patients with at least one associated anomaly was 52/86 (60%), with 7/86 (8%) who are from consanguineous parents; most commonly associated anomalies were cardiac 13/86 (15%). The average gestational age and birth weight were 36 ± 2 weeks and 2300 ± 570 g, respectively. Survival rates for the patients according to the Waterston classification was 80% in group A, 58% in group B, and 25% in group C (three patients died before surgery). Prematurity, the gap between the two ends of the esophagus, and preoperative respiratory status were the most significant factors affecting the survival. Late complication of EA/TEF include respiratory symptoms, especially in the first year, associating tracheomalacia and bronchopulmonary infections in about 24/45 (53%), recurrence of TEF 3/45 (7%), esophageal stricture 26/45 (58%), and gastroesophageal reflux 22/45 (49%). The high incidence of delayed diagnosis, low birth weight, and lack of advanced neonatological management are important contributory factors to the poor outcome. The frequency of late complications highlights the need for multidisciplinary clinics to follow these children's.

A Case of Exuberant Candidal Onychomycosis in a Child With Hyper IgE Syndrome

An 8-year-old girl with recurrent oral thrush as an infant and toddler, multiple diaper yeast infections, recurrent ear infections that required multiple ear-tube placements, a long history of mild atopic dermatitis, and at least 7 Staphylococcus aureus abscesses on the extremities presented with new-onset thickening of the thumbnail that had failed therapy with 40% urea cream (Figure 1). Of note, she had no history of bronchopulmonary infections. Periodic acidSchiff stained sections of a nail-plate clipping revealed yeast

Long-term efficacy, safety, and tolerability of Hizentra® for treatment of primary immunodeficiency disease

Hizentra(®) (20% subcutaneous immunoglobulin [SCIG]) was administered to subjects with primary immunodeficiency disease in two extension studies in the EU and US to assess long-term efficacy and tolerability. Subjects (aged 4-69 years) were treated for 148 weeks in the EU (N = 40; 5405 infusions) and 87 weeks in the US (N = 21; 1735 infusions). Weekly doses were 116.0 mg/kg (EU) and 193.2 mg/kg (US); IgG levels were 7.97 g/L (EU) and 11.98 g/L (US). Annualized rates of serious bacterial infections were 0.05 infections/subject/year (EU) and 0.06 infections/subject/year (US). Rates of any infection were 3.33 infections/subject/year (EU) and 2.38 infections/subject/year (US). The rate of bronchopulmonary infections was higher in the EU study. No treatment-related serious AEs occurred; no subject discontinued because of treatment-related AEs. Self-administered Hizentra afforded sustained effective protection from infections and favorable tolerability during an extended treatment period of up to 3 years.

P175 The significance of washed sputum culture in infants and children with bronchopulmonary infection since 1964

P175 The significance of washed sputum culture in infants and children with bronchopulmonary infection since 1964

Le syndrome de Protée : une cause exceptionnelle d’emphysème pulmonaire

The Proteus syndrome is a rare genetic disease which is characterized by the overgrowth of tissues, especially bone, connective and adipose tissue. This condition is related to a somatic mosaic activating mutation in the AKT1 oncogene. We report the case of a 25-year-old man, diagnosed with the Proteus syndrome at the age of 6 months. He exhibited an asymmetric overgrowth of the extremities leading to bilateral amputation of the legs at the age of 10 years. He was hospitalized for acute respiratory failure due to a bronchopulmonary infection. Severe bullous pulmonary emphysema, predominantly on the left, with mediastinal deviation, was diagnosed. The patient recovered with antibiotics. An assessment 2 months later revealed mild hypoxaemia (PaO2=75 mmHg) and severe airflow limitation (FEV1=1260 mL [28% th.], FEV1/V C=69%) with hyperinflation (TLC=7840 mL [107% th.], RV=6010 mL [253% th.]). The Proteus syndrome is a very rare cause of pulmonary emphysema. The pathophysiology of emphysema in this syndrome is unknown. It can be hypothesized that the development of pulmonary cysts leading to emphysema may share the same AKT1 activation pathway with lymphangioleiomyomatosis.

Giant Lambl’s excrescence: a rare incidental finding at autopsy

An 88 year old man collapsed unexpectedly while being transported to a medical examination due to suspected bronchopulmonary infection. Additionally, he had complained of diffuse abdominal pain several hours prior to his death. Resuscitation efforts were unsuccessful and he was pronounced dead at the scene. Due to the unexpected nature of his death, the deceased was referred for postmortem evaluation. His past medical history included chronic obstructive pulmonary disease and ischemic heart disease. Postmortem examination showed unremarkable external findings, except for palpably fractured ribs caused by closed chest compressions performed during attempted resuscitation. Internal examination revealed segmental intestinal infarction secondary to acute occlusion of the superior mesenteric artery by thrombus superimposed upon severe atherosclerosis. Macroscopically, the infarcted section of the intestine appeared gangrenous, edematous, and diffusely dark-purple in color. Sectioning of the heart revealed a small, sea anemone-like structure on the surface of the tricuspid valve measuring 1.2 cm in diameter (Figs. 1, 2). In addition, further autopsy findings included diffuse peritonitis and mild intraperitoneal hemorrhage. Microscopic examination of the aforementioned endocardial structure with hematoxylin-eosin (Fig. 3a, b), Movat’s pentachrome (Fig. 3c), and Masson’s trichrome stains showed fragments of gelatinous, arborescent tissue covered by hyperplastic endothelial cells. All of these structures were composed predominantly of a myxoid stroma with occasional elastic fibers and small amounts of collagen, typical of a papillary fibroelastoma. The cause of death was transmural intestinal necrosis caused by acute arterial thrombotic occlusion sustained as the result of severe mesenteric atherosclerosis.

Early Bacterial Bronchopulmonary Infection after Lung Transplantation: Bacterial Epidemiology and Diagnostic Value of Clinical and Biological Parameters

<h3>Purpose</h3> Postoperative infectious complications are key issues following lung transplantation (LT). Early bacterial pneumonia (EBP) worsen prognosis of LT. Assessment of bacterial epidemiology of EBP is necessary to optimize treatment of EBP, thus improving LT outcome. <h3>Methods and Materials</h3> From 2006 to 2010, all consecutive LT performed in our institution were included. Demographic and microbiologic data during the first 30 postoperative days after LT were collected. <h3>Results</h3> 102 LT (emphysema 46%, idiopathic fibrosis 38%) were performed during the study period. Among 831 bacteriological cultures of bronchial aspirate, 307 were positive. Evolution of bacterial epidemiology during the first 2 weeks is presented in figure 1. Donor colonization was associated with recipient infection with Methicilin-sensitive Staphylococcus aureus (MSSA) (OR=5,84; [1,87-18,27], p=0,0033) and Enterobacteria (0R=2,8; [1,15-6,83], p=0,037). Presence of purulent expectoration, contrary to fever, leukocyte count, chest X ray, impairment in lung function and CPIS scor, was associated with positive bacterial cultures (OR=1,99; IC [1,45-2,72] p=0,01). Interestingly, type of bacteria did not have any impact on mortality at day 30. <h3>Conclusions</h3> There is an evolution of bronchial bacterial epidemiology during the 2 weeks following LT with an increase in Pseudomonas aeruginosa proportion. Only purulent expectoration, but not other parameters currently used to diagnose post operative pneumonia, is associated with positive bacterial culture of bronchial aspiration. These findings highlight the challenging problems raised by the diagnosis of respiratory infection after LT.