Impact of Positive Donor Cultures on Postoperative Lung Transplantation Infectious Outcomes Anna Curtis, PharmD; Christine Pham, PharmD; Brett J. Pierce, PharmD, BCPS; Duc Nguyen, MD, PhD; Edward Graviss, PhD, MPH PURPOSE
RESULTS
Transmission risk of microbes present in donor lungs at time of donation to lung transplant recipients (LTR) is unclear. Infection is the second highest cause of 30-day (d) mortality. Guidelines for donor-derived infections recommend 7-14d of antibiotics in recipients of bacteremic donors. There is limited data assessing transmission of non-blood donor infections and outcomes post-lung transplantation. We sought to describe infectious outcomes within 90 days after lung transplant in patients with positive donor cultures.
Of 83 included patients, C. diff occurred in 11% (n=9) and MDRO occurred in 25% (n=21) of LTR within 90d. Donor cultures were 96% bacterial and 94% from lungs/sputum. Immediate organism clearance (organism identified in donor but not in LTR cultures) occurred in 83% of LTR (n=69). All donor-derived organisms were respiratory infections (RI) in the 14 LTRs that grew through post-op antibiotics. Median duration of post-op antibiotics was 14d (IQR 11-18) in these positive RI LTR vs 11d (IQR 9-15) in those who demonstrated immediate clearance. Positive RI LTR demonstrated organism clearance after a median of 4d (IQR 3-6).
METHODS
This was a single-center, retrospective, descriptive study. We reviewed LTR from 2016-2020 with positive donor cultures from any site. Patients were excluded if they had cystic fibrosis, a multiorgan or redo transplant, or active infection at time of transplant. Protocol post-op antibiotics included vancomycin and cefepime x7d with extension to 14d if positive donor cultures were reported. Our primary outcome was the incidence of infectious outcomes, defined as Clostridioides difficile (C. diff) and multi-drug resistant organisms (MDRO), within 90d post-lung transplantation. Secondary outcomes included transmission characterization, antibiotic regimens, and 90-day mortality.
CONCLUSION
While incidence of C. diff and MDRO was low and did not appear to correlate with antibiotic duration, LTR may benefit from decreased antibiotics duration given immediate clearance occurred in 83% of LTR. Our study suggests antibiotics past 7d may not be necessary in lung transplant patients with gram-positive respiratory cultures or with non-respiratory and/or non-bacteremic donor cultures.
PGY2 SOLID ORGAN TRANSPLANT PHARMACY RESIDENCY
Anna E Curtis, PharmD Anna earned her PharmD from the University of Houston College of Pharmacy in 2019. She completed her PGY1 residency at Houston Methodist Hospital. Following completion of her PGY2 residency, Anna has accepted a position as an Abdominal Transplant Pharmacist at Medical City Fort Worth. Primary project preceptor: Christine Pham, PharmD Presented at 2020 Virtual Vizient Pharmacy Network Conference, 2021 Virtual Midwest Pharmacy Residents Conference, and 2021 Virtual American Transplant Congress
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