Korean J Crit Care Med.  2015 May;30(2):103-108. 10.4266/kjccm.2015.30.2.103.

Lung Transplantation in a Patient with Pre-transplant Colonization of Extensively Drug-resistant Acinetobacter baumannii

• Lee HY
• Lee HY
• Shin SB
• Shin KS
• Lee BW
• Kim HW
• Lee S
• Kim SC

• KMID: 2227673
• DOI: http://doi.org/10.4266/kjccm.2015.30.2.103

Abstract

Colonization of the pre-transplant lung by multidrug-resistant bacteria affects short- and long-term outcomes of lung transplantation. However, there are no case reports on the colonization of a pre-transplant lung by drug-resistant Acinetobacter baumannii. We report a case of extensively drug resistant (XDR) A. baumannii colonization in the tracheobronchial tree that caused severe infectious complications after bilateral lung transplantation. A 23-year-old man diagnosed with bronchiolitis obliterans syndrome (BOS) 4 years earlier with a history of allogenic bone marrow transplantation for acute lymphoblastic leukemia was admitted to the hospital with dyspnea. Due to progressive hypercapnic respiratory failure, long-term mechanical ventilation was started after a tracheostomy was performed, and the patient underwent a bilateral lung transplantation to treat end-stage BOS. After the transplantation, the colonization of XDR A. baumannii caused severe bacterial pneumonia in the early postoperative period. Combined treatment with colistin and meropenem led to recovery from the pneumonia but caused drug-induced renal failure. Because many centers are willing to transplant candidates who are on mechanical ventilation or extracorporeal life support, the incidence of XDR A. baumannii colonization of pretransplant lungs is expected to increase. Further studies are needed to examine pre-transplant management strategies in patients colonized with XDR A. baumannii.

Keyword

Acinetobacter baumannii; drug resistance; lung transplantation

MeSH Terms

Acinetobacter baumannii*
Bacteria
Bone Marrow Transplantation
Bronchiolitis Obliterans
Colistin
Colon*
Drug Resistance
Dyspnea
Humans
Incidence
Lung
Lung Transplantation*
Pneumonia
Pneumonia, Bacterial
Postoperative Period
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Renal Insufficiency
Respiration, Artificial
Respiratory Insufficiency
Tracheostomy
Young Adult
Colistin

Figure

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  Fig. 1. Chest computed tomography taken before lung transplantation showed heterogeneously decreased lung attenuation with bronchial dilatation, suggesting advanced BOS.

• 

  Fig. 2. Bronchoscopy performed on POD 7 showed erythematous, inflammatory mucosa with profuse purulent sputum in both bronchi.

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  Fig. 3. Chest x-ray taken on POD 1 (A), POD 13 (B), POD 18 (C), and POD 27 (D), respectively. On POD 13, extensive bilateral infiltrations developed along with hypoxemic respiratory failure, which improved on POD 18. Chest x-ray on POD 27 showed almost complete regression of the pneumonic infiltrations.

• 

  Fig. 4. Bronchoscopy performed on POD 18 showed improved mucosal inflammation and purulent secretion.

Reference

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