Methods: This was a single center, retrospective quasi-experimental before-after study of lung transplant recipients from 7/06 to 2/17 comparing patients who received VPT to VCT for surgical prophylaxis. Patients receiving other surgical prophylaxis regimens due to allergy or colonization history were excluded. Donor and recipient culture data from bronchoscopy samples were collected to determine the incidence of Pseudomonas in the 14-day post-transplant period. The secondary outcome was the incidence of post-transplant CDC-defined pneumonia. Statistical analysis was performed using SAS 9.4 (Cary, NC).
Results: One hundred patients were included in the pre-protocol group (VPT), and 65 in the post-protocol group (VCT). Pseudomonas was recovered in recipient BALs on post-op day 2-14 in 8 (8%) patients in the VPT group compared to 5 (7.7%) patients in the VCT group (p=1.0). Mean time to Pseudomonas isolation was 8.4 days in the VPT group compared to 5.4 days in the VCT group. Incidence of pneumonia on post-op day 2-14 was 6% in the VPT group versus 3% in the VCT group (p=0.48). Surgical site infections were rare in the VCT group with an incidence of 1.5% (1/65).
Conclusion: Isolation of Pseudomonas was rare in both time periods and an increase was not detected when anti-pseudomonal coverage was removed from the surgical prophylaxis regimen. Safe deescalation of surgical prophylaxis regimens are an important antimicrobial stewardship initiative.
D. K. Lockman, None
K. A. Thom, None
A. Amoroso, None
M. Pajoumand, None
E. Heil, ALK-Abelló: Grant Investigator , Research grant .