Risk factors, management, and clinical outcomes of invasive Mycoplasma and Ureaplasma infections after lung transplantation.

Abstract

Mollicute infections, caused by Mycoplasma and Ureaplasma species, are serious complications after lung transplantation; however, understanding of the epidemiology and outcomes of these infections remains limited. We conducted a single-center retrospective study of 1156 consecutive lung transplants performed from 2010-2019. We used log-binomial regression to identify risk factors for infection and analyzed clinical management and outcomes. In total, 27 (2.3%) recipients developed mollicute infection. Donor characteristics independently associated with recipient infection were age ≤40 years (prevalence rate ratio [PRR] 2.6, 95% CI 1.0-6.9), White race (PRR 3.1, 95% CI 1.1-8.8), and purulent secretions on donor bronchoscopy (PRR 2.3, 95% CI 1.1-5.0). Median time to diagnosis was 16 days posttransplant (IQR: 11-26 days). Mollicute-infected recipients were significantly more likely to require prolonged ventilatory support (66.7% vs 21.4%), undergo dialysis (44.4% vs 6.3%), and remain hospitalized ≥30 days (70.4% vs 27.4%) after transplant. One-year posttransplant mortality in mollicute-infected recipients was 12/27 (44%), compared to 148/1129 (13%) in those without infection (P <.0001). Hyperammonemia syndrome occurred in 5/27 (19%) mollicute-infected recipients, of whom 3 (60%) died within 10 weeks posttransplant. This study highlights the morbidity and mortality associated with mollicute infection after lung transplantation and the need for better screening and management protocols.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1016/j.ajt.2023.08.019

Publication Info

Tam, Patrick CK, Rochelle Hardie, Barbara D Alexander, Michael E Yarrington, Mark J Lee, Chris R Polage, Julia A Messina, Eileen K Maziarz, et al. (2023). Risk factors, management, and clinical outcomes of invasive Mycoplasma and Ureaplasma infections after lung transplantation. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. p. S1600-6135(23)00657-3. 10.1016/j.ajt.2023.08.019 Retrieved from https://hdl.handle.net/10161/30388.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Tam

Patrick Chung Kay Tam

Assistant Professor of Medicine
Alexander

Barbara Dudley Alexander

Professor of Medicine

Clinical research related to infectious complications of solid organ and bone marrow transplantation, with a particular interest in the treatment and rapid diagnosis of fungal disease. Training the next generation of Transplant Infectious Disease Physicians is a special focus of mine as the Principal Investigator of our Interdisciplinary T32 Training Program funded the NIH. 

Yarrington

Michael Yarrington

Assistant Professor of Medicine
Lee

Mark Jae Lee

Assistant Professor of Pathology
Messina

Julia Antoinette Messina

Assistant Professor of Medicine

I am a Transplant Infectious Diseases Physician who specializes in the care of immunocompromised patients including solid organ and bone marrow transplant recipients and patients with HIV. My research interests are in infections and clinical outcomes in patients with hematologic malignancies.

Maziarz

Eileen Maziarz

Associate Professor of Medicine
Miller

Rachel Ann Miller

Professor of Medicine
Wolfe

Cameron Robert Wolfe

Professor of Medicine

HIV infection, Transplant-related infectious diseases, general infectious diseases, Biological and Emergency Preparedness for hospital systems, influenza and respiratory viral pathogens

Arif

Sana Arif

Assistant Professor of Medicine
Reynolds

John Michael Reynolds

Professor of Medicine
Perfect

John Robert Perfect

James B. Duke Distinguished Professor of Medicine

Research in my laboratory focuses around several aspects of medical mycology. We are investigating antifungal agents (new and old) in animal models of candida and cryptococcal infections. We have examined clinical correlation of in vitro antifungal susceptibility testing and with in vivo outcome. Our basic science project examines the molecular pathogenesis of cryptococcal infections. We have developed a molecular foundation for C. neoformans, including transformation systems, gene disruptions, differential gene expression screens, and cloning pathogenesis genes. The goal of this work is to use C. neoformans as a model yeast system to identify molecular targets for antifungal drug development. There are a series of clinical trials in fungal infections which are being coordinated through this laboratory and my work also includes a series of antibiotic trials in various aspects of infections. Finally, we have now been awarded a NIH sponsored Mycology Unit for 5 years with 6 senior investigators which is focused on C. neoformans as a pathogenic model system, but will include multiple areas of medical mycology from diagnosis to treatment.

Baker

Arthur Wakefield Baker

Associate Professor of Medicine

Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.