Pulmonary infections in critically ill lung transplant recipients

Abstract

Severe respiratory infection is a major reason acute lung allograft dysfunction and for ICU admission in lung transplant (LT) recipients. This review overlooks the epidemiological aspects of pulmonary infections in critically ill LT recipients, with regard to available literature data. Pulmonary infections include pneumonia and tracheobronchitis, with different short- and long-term prognosis. Microbial epidemiology depends on the delay to LT, and on patient's prior colonization. Community-acquired respiratory virus pneumonias rarely lead to admission into an intensive care unit. Diagnosis of acute lung allograft dysfunction with respiratory failure should first suggest a pulmonary infection, but the presence of an infectious agent in a respiratory sampling should not rule out the diagnosis of a specific disease. Clinical and CT-scan analyses ought to guide the initial treatment and microbiological investigations. Data from fiber-optic bronchoscopy will concur to rule out differential diagnosis.