S. Campos, M. Caramori, R. Teixeira, J. Afonso Jr, R. Carraro, T. Strabelli, M. Samano, P. Pêgo-Fernandes, F. Jatene

目标：本研究的目的是评估肺移植（LT）受体出现细菌性和真菌性肺炎的流行病学，评价这些微生物在捐赠者-受体之间的传播。

材料和方法：针对2003年8月至2007年4月期间的49例肺移植受体及其捐赠者，我们回顾性分析了所有支气管肺泡灌洗（BAL）细胞培养呈阳性的案例。

结果：在平均412天的随访中（范围是1至138天）共出现了108例肺炎。最常见的微生物为：绿脓杆菌（n = 36; 33.3%）、金黄色葡萄球菌（n = 29; 26.8%）和曲霉菌（n = 18; 16%）。其他霉菌感染分别为镰刀菌、新型隐球菌和巴西芽生菌。在31名BAL阳性捐赠者中，15例为金黄色酿脓葡萄球菌。21名患者（43%）在移植前已经定殖，其中16名存在潜在的化脓性肺病。绿脓杆菌是最常见的可以形成菌落的有机体（59%移植前培养呈阳性）。研究中共出现了11例菌血性，其中5例感染源来自于肺部。16例患者死亡，其中6名（37.5%）是由感染导致的。统计学分析结果显示了化脓性肺病患者移植前定殖微生物与肺移植后出现肺炎的关系（RR = 4.76; P = .04; 95% CI = 1.02–22.10）。在分析的其他因素中没有更显著的因素了。

结论：在肺移植受体中，细菌性和真菌性感染是常见的，会导致较高的死亡率。绿脓杆菌是最常见的呼吸道感染因素。本研究没有观察到捐赠者的肺部有机体对肺移植后肺炎有任何影响。不过，我们证明了移植前定殖微生物与化脓性肺移植受体早期感染肺炎之间的联系。

Bacterial and Fungal Pneumonias After Lung Transplantation
S. Campos, M. Caramori, R. Teixeira, J. Afonso Jr, R. Carraro, T. Strabelli, M. Samano, P. Pêgo-Fernandes, F. Jatene

Objective: The aim of this study was to evaluate the epidemiology of bacterial and fungal pneumonia in lung transplant (LT) recipients and to assess donor-to-host transmission of these microorganisms.

Materials and Methods: We retrospectively studied all positive cultures from bronchoalveolar lavage (BAL) of 49 lung transplant recipients and their donors from August 2003 to April 2007.

Results: There were 108 episodes of pneumonia during a medium follow-up of 412 days (range, 1–1328 days). The most frequent microorganisms were: Pseudomonas aeruginosa (n = 36; 33.3%), Staphylococcus aureus (n = 29; 26.8%), and Aspergillus spp. (n = 18; 16%). Other fungal infections were due to Fusarium spp., Cryptococcus neoformans, and Paracoccidioides brasiliensis. Of the 31 donors with positive BAL, 15 had S. aureus. There were 21 pretransplant colonized recipients (43%) and 16 of them had suppurative underlying lung disease. P. aeruginosa was the most frequent colonizing organism (59% of pretransplant positive cultures). There were 11 episodes of bacteremia and lungs were the source in 5 cases. Sixteen deaths occurred and 6 (37.5%) were due to infection. Statistical analyses showed association between pretransplant colonizing microorganisms from suppurative lung disease patients and pneumonias after lung transplantation (RR = 4.76; P = .04; 95% CI = 1.02–22.10). No other analyzed factor was significant.

Conclusions: Bacterial and fungal infections are frequent and contribute to higher mortality in lung transplant recipients. P. aeruginosa is the most frequent agent of respiratory infections. This study did not observe any impact of donor lung organisms on pneumonia after lung transplantation. Nevertheless, we demonstrated an association between pretransplant colonizing microorganisms and early pneumonias in suppurative lung transplant recipients.

Volume 40, Issue 3, Pages 822-824 (April 2008)

[责任编辑:刘 聪]