Abstract
Background
In lung transplant recipients, respiratory tract infections are associated with faster progression through stages of bronchiolitis obliterans syndrome and mortality. Common causative pathogens for respiratory tract infections (RTIs) include non-fermenting gram-negative bacilli (NFGNB). Data to guide optimal treatment durations for NFGNB RTIs in this population are limited.
Methods
This was a single-center, retrospective, cohort study of adult lung transplant recipients who received systemic antibiotic treatment for RTIs caused by NFNGB and had at least 28 days of post-treatment follow-up. Analyses were conducted for each patient’s initial NFGNB RTI as well as all independent NFGNB RTIs episodes. Groups were divided into NFGNB RTIs treated for a short (≤ 10 days) versus long (> 10 days) duration of effective antibiotic therapy. The primary outcome was the incidence of recurrent NFGNB RTIs within 28 days post-treatment. Recurrence was defined as isolation of the same organism in a respiratory culture requiring treatment with systemic antibiotics as determined by the prescribing physician.
Results
We included 207 lung transplant recipients with 334 NFGNB RTIs (n=129 short; n=205 long) from a period of January 1, 2010 to July 1, 2019. The most common causative pathogen was P. aeruginosa (77% and 82%) and most NFGNB RTIs were treated inpatient (60% and 53%) in both groups. The median duration of therapy was 10 days and 14 days for the short and long treatment durations, respectively. The primary outcome occurred in 14/129 (11%) of the NFGNB RTIs treated for ≤ 10 days and 28/205 (14%) of those treated for > 10 days. No difference in recurrence within 28 days was detected in NFGNB RTIs treated for ≤ 10 days (aOR, 0.69; 95% CI, 0.34-1.4; p=0.149). Use of adjunctive inhaled antibiotics was associated with reduced recurrence (aOR, 0.38; 95% CI, 0.16-0.92; p=0.032).
Conclusion
In lung transplant recipients with NFGNB RTIs, no difference in infection recurrence was detected between treatment durations for ≤ 10 days compared to > 10 days. Further investigation analyzing treatment durations for respiratory tract infections as well as the utility of adjunctive inhaled antibiotics are warranted in this patient population.
Disclosures
All Authors: No reported disclosures
Managing Viral Respiratory Tract Infections in Lung Transplant Recipients
