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Abstract

Background

Staphylococcus aureus (S. aureus) infections post-lung transplant lead to increased mortality. The impact of S. aureus peri-transplant respiratory cultures on post-transplant outcomes is unknown as is the optimal duration of peri-transplant antibiotics. We compared lung transplant recipients with and without S. aureus growth on peri-transplant cultures and the impact on 6-month outcomes including rejection, survival, and occurrence of S. aureus infections.

Methods

A single-center, retrospective study of lung transplant recipients between January 2017 and April 2021 was performed. Donor/recipient characteristics, microbiologic data, antibiotics, and 6-month outcomes were analyzed.

Results
In this 4.5-year study period, 229 patients underwent lung transplant. 121 (53%) had S. aureus growth on peri-transplant cultures, of which 84 (69%) were methicillin-susceptible (MSSA), 30 (25%) methicillin-resistant (MRSA), and 7 (6%) had MSSA and MRSA. Median duration of antibiotics post-transplant was 28-days in the S. aureus group. 67% of non-S. aureus recipients received S. aureus targeting antibiotics (p = < 0.001) for other indications for a median of 13-days. In the S. aureus cohort, donors were younger (median age 33 vs 38 years, p = 0.027) and more donors died from drug intoxication (50% vs 31%, p = 0.005) [Table 1]. Recipient baseline characteristics and median length of hospitalization were similar in both cohorts. There were no statistically significant differences in 6-month outcomes, including rates of rejection or survival [Figure 1]. Having grown S. aureus in peri-transplant cultures was not associated with a higher incidence of post-transplant S. aureus infections (10% vs 13%, p = 0.534). Patients who had a S. aureus infection post-transplant had lower 6-month survival that was not statistically significant (85% vs 93%, p = 0.131).
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Conclusion

The growth of S. aureus on peri-transplant respiratory cultures with a median 4-week antibiotic course does not increase the risk of having a S. aureus infection post-transplant and is not associated with increased mortality or rejection at 6-months. The impact of a shorter duration of peri-transplant antibiotics on recurrence of infection and outcomes needs to be further studied.

Disclosures

Nicolas C. Issa, MD, AiCuris: Grant/Research Support|Merck: Grant/Research Support.

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Author notes

Session: 234. Infections in Immunocompromised Individuals

Saturday, October 22, 2022: 12:15 PM

© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
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