Understanding the Concept of Health Care-Associated Pneumonia in Lung Transplant Recipients.

BACKGROUND Limited data are available regarding the etiologic impact of health care-associated pneumonia (HCAP) in lung transplant recipients. Therefore, our aim was to evaluate the microbiologic differences between HCAP and hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) in lung transplant recipients with a radiographically confirmed diagnosis of pneumonia. METHODS We performed a retrospective cohort study of lung transplant recipients with pneumonia at one transplant center over a 7-year period. Eligible patients included lung transplant recipients who developed a first episode of radiographically confirmed pneumonia ≥ 48 h following transplantation. HCAP, HAP, and VAP were classified according to the American Thoracic Society/Infectious Diseases Society of America 2005 guidelines. χ 2 and Student t tests were used to compare categorical and continuous variables, respectively. RESULTS Sixty-eight lung transplant recipients developed at least one episode of pneumonia. HCAP (n = 42;62%) was most common, followed by HAP/VAP (n = 26;38%) stratified in HAP (n = 20;77%) and VAP (n = 6;23%). Pseudomonas aeruginosa was the predominantly isolated organism (n = 22;32%), whereas invasive aspergillosis was uncommon ( P = .009). Opportunistic pathogens were less frequently identified in lung transplant recipients with HCAP than in those with HAP/VAP (7% vs 27%; P = .02). Lung transplant recipients with HCAP had a similar mortality at 90 days (n = 9 [21%] vs n=4 [15%]; P = .3) compared with patients with HAP/VAP. CONCLUSIONS HCAP was the most frequent infection in lung transplant recipients. MDR pathogens and opportunistic pathogens were more frequently isolated in HAP/VAP. There were no differences in 30- and 90-day mortality between lung transplant recipients with HCAP and those with HAP/VAP. CHEST 2015;148(2):516-522