Risk Factors for and Outcomes Following Early Acquisition of Mycobacterium abscessus Complex After Lung Transplantation

Author:

Nick Sophie E1ORCID,Yarrington Michael E23ORCID,Reynolds John M4ORCID,Anderson Deverick J23ORCID,Baker Arthur W23ORCID

Affiliation:

1. Duke University School of Medicine , Durham, North Carolina , USA

2. Division of Infectious Diseases, Duke University School of Medicine , Durham, North Carolina , USA

3. Duke Center for Antimicrobial Stewardship and Infection Prevention , Durham, North Carolina , USA

4. Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine , Durham, North Carolina , USA

Abstract

Abstract Background Lung transplant recipients are at increased risk of Mycobacterium abscessus complex (MABC) acquisition and invasive infection. We analyzed risk factors and outcomes of early post–lung transplant MABC acquisition. Methods We conducted a retrospective matched case–control study of patients who underwent lung transplant from 1/1/2012 to 12/31/2021 at a single large tertiary care facility. Cases had de novo MABC isolation within 90 days post-transplant. Controls had no positive MABC cultures and were matched 3:1 with cases based on age and transplant date. Recipient demographics and pre-/peri-operative characteristics were analyzed, and a regression model was used to determine independent risk factors for MABC acquisition. We also assessed 1-year post-transplant outcomes, including mortality. Results Among 1145 lung transplants, we identified 79 cases and 237 matched controls. Post-transplant mechanical ventilation for >48 hours was independently associated with MABC acquisition (adjusted odds ratio, 2.46; 95% CI, 1.29–4.72; P = .007). Compared with controls, cases required more days of hospitalization after the MABC index date (28 vs 12 days; P = .01) and had decreased 1-year post-transplant survival (78% vs 89%; log-rank P = .02). One-year mortality appeared highest for cases who acquired M. abscessus subsp. abscessus (31% mortality) or had extrapulmonary infections (43% mortality). Conclusions In this large case–control study, prolonged post-transplant ventilator duration was associated with early post–lung transplant MABC acquisition, which in turn was associated with increased hospital-days and mortality. Further studies are needed to determine the best strategies for MABC prevention, surveillance, and management.

Funder

National Institute of Allergy and Infectious Diseases of the National Institutes of Health

Stead Program of the Duke University Department of Medicine

Publisher

Oxford University Press (OUP)

Reference40 articles.

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