Background Hospital-acquired (HAP) and ventilator-associated pneumonia (VAP) are important complications early (<30 days) after lung transplantation (LT). However, current incidence, associated factors, and outcomes are not well reported. Methods LT recipients transplanted at our institution (July 2019–January 2020 and October 2021–November 2022) were prospectively included. We assessed incidence and presentation of pneumonia and evaluated the impact of associated factors using regression models. We also evaluated molecular relatedness of respiratory pathogens collected peri-transplant and at pneumonia occurrence using pulsed-field gel electrophoresis (PFGE). Results In the first 30 days post-LT, 25/270 (9.3%) recipients were diagnosed with pneumonia (68% [17/25] VAP; 32% [8/25] HAP). Median time to pneumonia was 11 days (IQR, 7–13); 49% (132/270) of donor and 16% (44/270) of recipient respiratory peri-transplant cultures were positive. However, pathogens associated with pneumonia were not genetically related to either donor or recipient cultures at transplant, as determined by PFGE. Diagnosed pulmonary hypertension (HR, 4.42; 95% CI, 1.62–12.08) and immunosuppression use (HR, 2.87; 95% CI, 1.30–6.56) were pre-transplant factors associated with pneumonia. Pneumonia occurrence was associated with longer hospital stay (HR, 5.44; 95% CI, 2.22–13.37) and VAP with longer ICU stay (HR, 4.31; 95% CI, 1.73–10.75) within the first 30 days post-transplantation; 30- and 90-day mortality were similar. Conclusions Prospectively assessed early pneumonia incidence occurred in ∼10% of LT. Populations at increased risk for pneumonia occurrence include LT with pre-transplant pulmonary hypertension and pre-transplant immunosuppression. Pneumonia was associated with increased healthcare use, highlighting the need for further improvements by preferentially targeting higher-risk patients.

中文翻译：

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肺移植术后早期医院获得性肺炎和呼吸机相关性肺炎：关于发病率、病原体来源和结局的前瞻性研究


背景 医院获得性肺炎 （HAP） 和呼吸机相关性肺炎 （VAP） 是肺移植 （LT） 后早期 （x3C30 天） 的重要并发症。然而，目前的发病率、相关因素和结局没有得到很好的报告。方法 前瞻性纳入在我们机构移植的 LT 受者 （2019 年 7 月至 2020 年 1 月和 2021 年 10 月至 2022 年 11 月）。我们评估了肺炎的发病率和表现，并使用回归模型评估了相关因素的影响。我们还使用脉冲场凝胶电泳 （PFGE） 评估了移植周围和肺炎发生时收集的呼吸道病原体的分子相关性。结果 在 LT 后的前 30 天内，25/270 （9.3%） 受者被诊断为肺炎 （68% [17/25] VAP;32% [8/25] HAP）。肺炎的中位时间为 11 天 （IQR， 7-13）;49% （132/270） 的供体和 16% （44/270） 的受者呼吸道移植周围培养呈阳性。然而，根据 PFGE 确定，与肺炎相关的病原体与移植时的供体或受体培养物没有遗传关系。诊断为肺动脉高压 （HR， 4.42;95% CI， 1.62–12.08） 和免疫抑制使用 （HR， 2.87;95% CI， 1.30–6.56） 是与肺炎相关的移植前因素。在移植后的前 30 天内，肺炎的发生与住院时间延长 （HR， 5.44;95% CI， 2.22-13.37） 和 VAP 与 ICU 住院时间较长 （HR， 4.31;95% CI， 1.73-10.75） 相关;30 天和 90 天死亡率相似。结论： 前瞻性评估早期肺炎发病率发生在 ∼10% 的 LT 中。肺炎发生风险增加的人群包括移植前肺动脉高压和移植前免疫抑制的 LT。 肺炎与医疗保健使用的增加有关，这凸显了通过优先针对高风险患者来进一步改进的必要性。