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Pulmonary complications of solid-organ transplantation
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
Bacterial pneumonia may be either nosocomial or community-acquired. The time of onset, responsible pathogens and prognosis are distinct for these two modes of infection. Nosocomial pneumonia is almost exclusively a perioperative complication. Gram-negative pathogens predominate, but Staphylococcus aureus and, in some centres, Legionella species are also encountered. An increase in the prevalence of methicillin-resistant Staphylococcus aureus infections (MRSI) has been documented and must be considered when initiating empirical antibiotic therapy. The need for prolonged postoperative mechanical ventilation is a major risk factor for nosocomial pneumonia following transplantation. Impairment in cough that accompanies extensive surgical manipulation of the thorax or upper abdomen also contributes to the risk. Among lung transplant recipients, additional factors can potentially compromise local pulmonary defences: narrowing of the bronchial anastomosis, diminished cough reflex due to lung denervation, disruption of pulmonary lymphatics, and impairment in the mucociliary ‘escalator’ resulting from ischaemic injury to the bronchial mucosa. Passive transfer of occult pneumonia initially acquired by the donor is another circumstance unique to lung transplantation, though the presence of organisms on Gram stain of donor bronchial washings is not predictive of subsequent pneumonia in the recipient.2 Although the incidence of nosocomial pneumonia has declined to less than 10 per cent in liver and heart transplant recipients and to approximately 15 per cent in lung transplant recipients, mortality remains high.
Novel applications for serum procalcitonin testing in clinical practice
Published in Expert Review of Molecular Diagnostics, 2018
Justin J. Choi, Matthew W. McCarthy
In our experience, high PCT values are reliable and specific for bacterial pneumonia in the presence of AECOPD as they strongly correlate with higher temperature, leukocytosis, and more severe illness even in the setting of an unremarkable chest radiograph, which may suggest the possibility of occult pneumonia [106]. However, at lower PCT values (0.25–0.50 ng/mL), the assay is unable to distinguish between virus-associated and bacterial-associated AECOPD [107–109]. Given the remarkable difference in how these two forms of pulmonary infection are treated, our center and others are currently investigating novel trials designed to rapidly and reliably discriminate between these two conditions.