Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2020 Apr 29;20(1):109.
doi: 10.1186/s12890-020-1151-9.

Worldwide clinical practices in perioperative antibiotic therapy for lung transplantation

Benjamin Coiffard  1   2   3 , Eloi Prud'Homme  4 , Sami Hraiech  4 , Nadim Cassir  5 , Jérôme Le Pavec  6 , Romain Kessler  7 , Federica Meloni  8 , Marc Leone  9 , Pascal Alexandre Thomas  10 , Martine Reynaud-Gaubert  11 , Laurent Papazian  4
Affiliations
Multicenter Study

Worldwide clinical practices in perioperative antibiotic therapy for lung transplantation

Benjamin Coiffard et al. BMC Pulm Med. .

Abstract

Background: Infection is the most common cause of mortality within the first year after lung transplantation (LTx). The management of perioperative antibiotic therapy is a major issue, but little is known about worldwide practices.

Methods: We sent by email a survey dealing with 5 daily clinical vignettes concerning perioperative antibiotic therapy to 180 LTx centers around the world. The invitation and a weekly reminder were sent to lung transplant specialists for a single consensus answer per center during a 3-month period.

Results: We received a total of 99 responses from 24 countries, mostly from Western Europe (n = 46) and the USA (n = 34). Systematic screening for bronchial recipient colonization before LTx was mostly performed with sputum samples (72%), regardless of the underlying lung disease. In recipients without colonization, antibiotics with activity against gram-negative bacteria resistant strains (piperacillin / tazobactam, cefepime, ceftazidime, carbapenems) were reported in 72% of the centers, and antibiotics with activity against methicillin-resistant Staphylococcus aureus (mainly vancomycin) were reported in 38% of the centers. For these recipients, the duration of antibiotics reported was 7 days (33%) or less (26%) or stopped when cultures of donor and recipients were reported negatives (12%). In recipients with previous colonization, antibiotics were adapted to the susceptibility of the most resistant strain and given for at least 14 days (67%).

Conclusion: Practices vary widely around the world, but resistant bacterial strains are mostly targeted even if no colonization occurs. The antibiotic duration reported was longer for colonized recipients.

Keywords: Antibiotic therapy; Bronchial colonization; Lung transplantation; Perioperative; Survey.

PubMed Disclaimer

Conflict of interest statement

Pr. Marc Leone discloses financial support from MSD (Merck & Co., Inc., Kenilworth, NJ, USA) and Pfizer (Paris, France). Pr. Laurent Papazian reports non-financial support from Dräger SAS France, non-financial support from Maquet SAS France, outside the submitted work. Other authors have no conflict to disclose. Pr. Federica Meloni is a member of the Editorial Board of the BMC Pulmonary Medicine journal as an Associate Editor of the section “Infectious, Rare and Idiopathic Pulmonary Diseases”.

Figures

Fig. 1
Fig. 1
World map representing the lung transplant centers answering the survey and the number of responses by country. The map was generated with the public R software using the “maps” package
Fig. 2
Fig. 2
Histogram and Boxplot representing the distribution of the number of lung transplantations per center performed in 2017. The bars are per slice of 5 lung transplantations. The boxplot corresponds to the median with the interquartile range (distance between the first and third quartiles); the lower and upper whiskers extend from the hinge to the lowest and highest (respectively) values that are within 1.5 x IQR of the hinge LTx: lung transplantation.
Fig. 3
Fig. 3
Bar plot representing the number of responses per antibiotic for Case 1 about antibiotic prophylaxis for interstitial lung disease without bronchial colonization. Amox+ca: amoxicillin+clavulanic acid; ampi+sulbactam: ampicillin+sulbactam; piper+tazo: piperacillin+tazobactam; 1GC: first-generation cephalosporins; 2GC: second-generation cephalosporins; 3GC: third-generation cephalosporins; 4GC: fourth-generation cephalosporins
Fig. 4
Fig. 4
Polar bar plot representing the number of responses for the duration of antibiotic prophylaxis in the context of no colonization (a, Case 1) or colonization (b, Case 2). Cultures (plot a): until donor and recipient cultures are reported negatives; Cultures (plot b): according to donor and recipient cultures; Chest tubes: until indwelling chest tubes are removed; ICU: until ICU discharge; Clinical: according to clinical course
See this image and copyright information in PMC

References

    1. Yusen RD, Edwards LB, Kucheryavaya AY, et al. The registry of the International Society for Heart and Lung Transplantation: thirty-second official adult lung and heart-lung transplantation report--2015; focus theme: early graft failure. J Heart Lung Transplant. 2015;34:1264–1277. - PubMed
    1. Verleden SE, Sacreas A, Vos R, Vanaudenaerde BM, Verleden GM. Advances in understanding bronchiolitis obliterans after lung transplantation. Chest. 2016;150:219–225. - PubMed
    1. Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007;357:2601–2614. - PubMed
    1. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70:195–283. - PubMed
    1. Huang YJ, LiPuma JJ. The microbiome in cystic fibrosis. Clin Chest Med. 2016;37:59–67. - PMC - PubMed

Publication types

Substances