Mycobacterium Abscessus Infections in Lung Transplant Recipients: The International Experience

J Heart Lung Transplant. 2006 Dec;25(12):1447-55. doi: 10.1016/j.healun.2006.09.003.

Abstract

Background: The clinical significance of Mycobacterium abscessus infection in the lung transplant population is not well understood.

Methods: An international survey was performed to determine the incidence and clinical outcomes of M abscessus infections before and after lung transplantation.

Results: Thirty-one (50%) of the 62 transplant centers affiliated with the International Society of Heart and Lung Transplantation responded to the survey. Of 5,200 transplants performed, 17 patients (0.33%) (M/F, 12:5) were identified with M abscessus after transplantation. Two patients had respiratory colonization before lung transplantation. Post-transplantation M abscessus infections occurred in the pulmonary allograft in 12, in skin/soft tissue in 3, or both in 2. Median time to diagnosis after transplantation was 18.5 months (range, 1-111 months). Therapies included multiple antibiotics in 16, surgical débridement in 2, interferon-gamma in 1, or no therapy owing to presumed colonization in 1. Eleven (73%) of 16 treated patients had a radiologic or microbiologic response to treatment. Concurrent infections were common, with Aspergillus (n = 8) and Pseudomonas aeruginosa (n = 5) most frequently seen. Death in 2 patients was attributed to M abscessus. Ten of 17 patients are alive and considered cured.

Conclusions: M abscessus infection in the lung transplant recipient is uncommon and challenging; however, successful treatment can occur. Prolonged combination anti-microbial therapy is required for pulmonary involvement, and surgical débridement is recommended for cutaneous lesions. Concurrent infections are common and may contribute to mortality in this immunosuppressed population.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Debridement
  • Drug Therapy, Combination
  • Female
  • Humans
  • Incidence
  • Internationality
  • Lung Diseases / drug therapy
  • Lung Diseases / etiology
  • Lung Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Mycobacterium Infections, Nontuberculous / complications
  • Mycobacterium Infections, Nontuberculous / epidemiology*
  • Mycobacterium Infections, Nontuberculous / etiology*
  • Mycobacterium Infections, Nontuberculous / therapy
  • Skin Diseases, Bacterial / etiology
  • Skin Diseases, Bacterial / surgery
  • Soft Tissue Infections / etiology
  • Soft Tissue Infections / therapy
  • Surveys and Questionnaires

Substances

  • Anti-Bacterial Agents