T3. Studies of the epidemiology of infections in transplant patients and patients with impaired immunity due to underlying disease or immunosuppressive drugs
John R. Perfect, MD
Professor of Medicine
Durham, North Carolina
Disclosure: Amplyx: Advisory Board, Grant/Research Support
Astellas Pharma: Consultant
Cidara: Advisory Board
F2G: Advisory Board
Matinas: Advisory Board
Mayne: Advisory Board, Grant/Research Support
Merck: Advisory Board, Grant/Research Support
Minnetronix: Advisory Board, Grant/Research Support
Pfizer: Grant/Research Support
Viamet: Advisory Board
Vical: Advisory Board
Barbara D. Alexander, MD, MHS
Professor of Medicine and Pathology
Disclosure: Astellas Pharma: Advisory Board, Consultant, Grant/Research Support, Other Financial or Material Support, Research Grant
Cidara: grant to institution, Research Grant
F2G: grant to institution, Research Grant
Lediant: grant to institution, Grant/Research Support, Other Financial or Material Support, Research Grant
Scynexis: Consultant, grant to institution, Independent Contractor, Research Grant
Mycoplasma and Ureaplasma species can cause invasive infections early after lung transplant that are difficult to diagnose and associated with substantial morbidity, including hyperammonemia syndrome. Data on the epidemiology and clinical outcomes of these infections are needed to inform clinical management and screening protocols for donors and recipients.
We retrospectively collected clinical data on all patients who underwent lung transplantation at our hospital from 1/1/2010 - 4/15/2019 and subsequently had positive cultures or PCR studies for M. hominis or Ureaplasma spp. Patients with positive studies from only the genitourinary tract were excluded. We analyzed donor and recipient clinical characteristics, treatment courses, and outcomes for up to 2 years after transplant.
Of 1055 total lung transplant recipients, 20 (1.9%) patients developed invasive infection with M. hominis or Ureaplasma spp. M. hominis caused the first 10 infections (2010-2016), and Ureaplasma spp. caused 10 subsequent infections (2017-2019). Date of first positive culture or PCR study occurred a median of only 19 days after transplant (range, 4-90 days). Median donor age was 31 years (range, 18-45 years), and chest imaging for 16 (80%) donors revealed airspace disease compatible with aspiration.
Infection outside of the respiratory tract was confirmed for 13 (65%) recipients, including 8 patients with M. hominis empyemas (Figure 1). 10 (50%) patients developed altered mental status that was temporally associated with infection; 8 (80%) of these patients had elevated serum ammonia levels, including 3 patients with M. hominis infection. Median duration of therapy was 6 weeks (IQR, 4-9 weeks), consisting of combination antimicrobial regimens for nearly all patients. Additional postoperative complications were common, and 11 (55%) patients died within 1 year after transplant (median, 117 days; IQR, 65-255 days) (Figure 2).
Ureaplasma and M. hominis infections occurred early after lung transplant and were associated with substantial morbidity and mortality. Transplant clinicians should have low thresholds for performing specific diagnostic testing for these organisms. Protocols for donor and recipient screening and management need to be developed.