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Microbiological findings in bronchoalveolar lavage fluid from lung transplant patients in Sweden

Journal article
Authors Anna Stjärne Aspelund
Helena Hammarström
Malin Inghammar
Hillevi Larsson
Lennart Hansson
Gerdt C. Riise
Vanda Friman
Bertil Christensson
Lisa I. Påhlman
Published in Transplant Infectious Disease
Volume 20
Issue 6
ISSN 1398-2273
Publication year 2018
Published at Institute of Biomedicine, Department of Infectious Medicine
Language en
Links doi.org/10.1111/tid.12973
Keywords bronchoalveolar lavage fluid, lung infections, lung transplantation, microbiology
Subject categories Infectious Medicine

Abstract

© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Background: Lung transplant patients experience a high risk of airway infections and microbial colonization of the lung due to constant exposure to the environment through inhaled microorganisms, denervation, reduced ciliary transport, and decreased cough. Methods: In this nationwide prospective study on Swedish lung transplant patients, we evaluated the microbiological panorama of bacteria, fungi, and virus found in bronchoalveolar lavage fluid (BALF) obtained the first year after lung transplantation (LTx). Differences in microbiological findings depending of concomitant signs of infection and background factors were assessed. Results: A total of 470 bronchoscopies from 126 patients were evaluated. Sixty-two percent (n = 293) of BALF samples had positive microbiological finding(s). Forty-six percent (n = 217) had bacterial growth, 29% (n = 137) fungal growth, and 9% (n = 43) were positive in viral PCR. In 38% of BALF samples (n = 181), a single microbe was found, whereas a combination of bacteria, fungi or virus was found in 24% (n = 112) of bronchoscopies. The most common microbiological findings were Candida albicans, Pseudomonas aeruginosa and coagulase negative Staphylococcus (in 42 (33%), 36 (29%), and 25 (20%) patients, respectively). Microbiological findings were similar in BALF from patients with and without signs of lung infection and the frequency of multidrug resistant (MDR) bacteria was low. No significant association was found between background factors and time to first lung infection. Conclusion: This study gives important epidemiologic insights and reinforces that microbiological findings have to be evaluated in the light of clinical symptoms and endobronchial appearance in the assessment of lung infections in lung transplant patients.

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