Infections Management in the Lung Transplant Setting in Italy: A Web-Survey

Abstract

Introduction: Infections significantly impact morbidity and mortality in lung transplant (LuTx) recipients. This survey focused on documenting current practices regarding the prevention and management of infections in LuTx in Italy.

Methods: A 52-question survey was administered online in the period from December 1, 2023, to January 31, 2024, assessing center characteristics, Tx team organization, microbiological investigations, infection prevention, and management. All Italian LuTx centers were invited to participate.

Results: Nine out of 10 Italian LuTx centers answered. Most centers (6/9, 67%) performed LuTx only on adults. Chronic infection or colonization by Mycobacterium abscessus and Burkholderia cenocepacia is considered a contraindication to LuTx in five and two centers, respectively. For cytomegalovirus D+/R- patients, prophylaxis is used in six centers (67%), with a variable duration from 3 to 12 months. Two centers also use IgG. Three centers (33%) use a pre-emptive strategy. Four centers (45%) screen for Human herpesvirus 8 infection. Regarding antibiotic prophylaxis, most centers (6/9, 67%) utilise a dual regimen of anti-pseudomonal penicillin plus glycopeptide. The two most common durations of antibiotic prophylaxis were 72 h and 7 days, each reported by two centers (22%). Targeted prophylaxis against fungal infections is employed by a minority of centers (4/9, 44%). Inhaled amphotericin B is the most common antifungal, used as targeted prophylaxis (2/4, 50%) and universal prophylaxis (2/5, 40%). Almost all centers (8/9, 89%) involve the Tx infectious diseases specialist in the recipient management since the pre-listing period.

Conclusion: There is considerable heterogeneity in infection management among Italian LuTx centers. Establishing a shared platform for data collection and outcome evaluation is essential to improve infection management.

Keywords: donor‐derived infections | lung transplant | prophylaxis.