1091. Nontuberculous Mycobacterial Infection Among Lung Transplant Recipients A Fifteen-Year Experience 1990-2005
Session: Poster Abstract Session: Infections After Solid Organ Transplants
Saturday, October 22, 2011
Room: Poster Hall B1
Background: 

To define the incidence of colonization and infection with nontuberculous mycobacteria (NTM) after lung transplantation and outcomes after treatment.

Methods: 

Retrospective cohort study at a single tertiary care center. Between August 1990 and July 2005, 237 patients underwent initial lung transplantation. Medical records were reviewed to determine the incidence of colonization and infection with NTM and the outcomes of patients with NTM infections. Pulmonary NTM infection was defined according to current American Thoracic Society (ATS) criteria. A radiologist blinded to the microbiology and clinical data reviewed all chest radiographs and chest computed tomography scans for the patients.

Results: 

NTM were isolated from 53 of 237 patients (22.4%) after lung transplantation over a median of 25.2 months of follow-up. The most common NTM isolated was M. avium (69.8%), followed by M. abscessus (9.4%) and M. gordonae (7.5%). Among these 53 patients only 3 patients met ATS criteria for pulmonary disease and all had M. avium. Two received treatment, one remained untreated; two (one untreated, one treated) died of other causes 40 and 70 months after their first positive culture. One patient had recurrent colonization after treatment. Another three patients met clinical and microbiologic ATS criteria, but were excluded due to concomitant Aspergillus sp.  isolation on bronchoalveolar lavage. They were not treated for NTM infection and did not have persistent colonization. A total of 47 patients who met microbiologic but not radiographic criteria for pulmonary infection were not treated and were found to have only transient colonization.Four of the 53 patients had surgical site infections, three due to M. abscessus, and one due to M.chelonae. Three of these patients had persistent infection necessitating chronic suppressive therapy and one died from NTM infection.

Conclusion: 

Isolation of NTM from lung transplant recipients was common. Most isolates occurred among asymptomatic patients and were transient. NTM can cause significant pulmonary and surgical site infections.


Subject Category: O. Transplant infectious diseases

BM Knoll, MD, PhD1, Shanthi Kappagoda, MD, MPH2, Hilary J Goldberg, MD3, Ritu Gill, MBBS4, Kathleen Boyle, RN5, Anne Louise Fuhlbrigge, MD5, Lindsey Baden, MD6,7 and Francisco Marty, MD5,6,8, (1)Infectious Diseases, Brigham and Wome's Hospital, Boston, MA, (2)Stanford University, Stanford, CA, (3)Pulmonary Medicina, Brigham and Wome's Hospital, Boston , MA, (4)Radiology, Brigham and Women's, Boston, MA, (5)Brigham and Women's Hospital, Boston, MA, (6)Harvard Medical School, Boston, MA, (7)Brigham and Women's Hospital, Brookline, MA, (8)Dana-Farber Cancer Institute, Boston, MA

Disclosures:

B. Knoll, None

S. Kappagoda, None

H. J. Goldberg, None

R. Gill, None

K. Boyle, None

A. L. Fuhlbrigge, None

L. Baden, None

F. Marty, None

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