BACKGROUND/AIMS: Infections are major causes of both early and late death after lung transplantation (LT). The development of prophylaxis strategies has altered the epidemiology of post-LT infections; however, recent epidemiological data are limited. We evaluated infections after LT at our institution by time of occurrence, site of infections, and microbiologic etiologies. METHODS: All consecutive patients undergoing lung or heart-lung transplantation between October 2008 and August 2014 at our institution were enrolled. Cases of infections after LT were initially identified from the prospective registry database, which was followed by a detailed review of the patients' medical records. RESULTS: A total of 108 episodes of post-LT infections (56 bacterial, 43 viral, and nine fungal infections) were observed in 34 LT recipients. Within 1 month after LT, the most common bacterial infections were catheter-related bloodstream infections (42%). Pneumonia was the most common site of bacterial infection in the 2- to 6-month period (28%) and after 6 months (47%). Cytomegalovirus was the most common viral infection within 1 month (75%) and in the 2- to 6-month period (80%). Respiratory viruses were the most common viruses after 6 months (48%). Catheter-related candidemia was the most common fungal infection. Invasive pulmonary aspergillosis developed after 6 months. Survival rates at the first and third years were 79% and 73%, respectively. CONCLUSIONS: Although this study was performed in a single center, we provide valuable and recent detailed epidemiology data for post-LT infections. A further multicenter study is required to properly evaluate the epidemiology of post-LT infections in Korea.
Adult ; Bacterial Infections/diagnosis/*microbiology/mortality ; Catheter-Related Infections/microbiology/virology ; Cytomegalovirus Infections/virology ; Female ; Heart-Lung Transplantation/*adverse effects/mortality ; Humans ; Kaplan-Meier Estimate ; Lung Transplantation/*adverse effects/mortality ; Male ; Medical Records ; Middle Aged ; Mycoses/diagnosis/*microbiology/mortality ; Pneumonia, Bacterial/microbiology ; Registries ; Republic of Korea/epidemiology ; Risk Factors ; Time Factors ; Treatment Outcome ; Virus Diseases/diagnosis/mortality/*virology

OBJECTIVETo explore disease progression and prognosis factors of novel influenza A (H1N1) in immunocompromised patients with or without hematologic disease.

METHODA total of 76 confirmed novel influenza A (H1N1) infection patients from November 2009 to March 2010 included in the study, their clinical feature was analyzed, and the relationship between clinical feature and outcome was explored retrospectively by multivariate analysis method.

RESULTSThe whole 76 patients were administrated of oseltamivir. Among the 76 patients, 46 were severe and 23 were critical. Of the 6 patients with immunocompromised hematologic disease, 2 were severe and 4 were critical, case-fatality rate was 66.67% (4/6). The case-fatality rate of patients with non-hematologic disease was 10.42% (5/48). Multivariable logistic-regression analysis showed that immunocompromised hematologic disease (P = 0.0008, odds ratio:75.368; 95% CI, 5.980 to 949.853) and age (P = 0.0380) were independent risk factors for death. And other variables such as chronical lung disease, interval time from the onset of illness and lymphocyte count had no statistical significance (P > 0.05).

CONCLUSIONSThe novel influenza A (H1N1) patients with immunocompromised hematologic disease has a poor prognosis, they can deteriorate quickly and have high mortality, it may aid clinicians to pay high attention to these people.

Adult ; Aged ; Aged, 80 and over ; Female ; Hematologic Diseases ; diagnosis ; mortality ; virology ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; diagnosis ; mortality ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo analyze the diagnosis and treatment characteristics of patients with severe Influenza A.

METHODA retrospective investigation on the clinical manifestation, chest radiography, electronic fiber bronchoscopy and the histology of the cast, rescue course and outcome was conducted in 15 children with severe influenza A during January to May of 2013.

RESULTEleven cases were male, the range of age was 2 to 6 years; 5 cases were female, the range of age was 1 month to 6 years, accouting for 4.2% of hospitalized children with influenza. Three patients had an underlying chronic disease, two had nephrotic syndrome, and one had congenital heart disease. All the 15 cases were diagnosed as severe influenza A virus infection complicated with pneumonia and respiratory failure, of whom 10 cases were infected with H1N1 virus , the other 5 cases could not be identified as H1N1 virus by using H1N1 kit, but none of the 15 cases were infected with H7N9 virus. Of 15 cases, 8 had atelectasis, 4 had pneumothorax, 3 had pneumomediastinum, 4 had pleural effusion, 1 had pneumorrhagia; 12 patients required mechanical ventilation. 1 only required noninvasive mask CPAP, 2 did not require assisted ventilation, they were just given mask oxygen. Seven cases' sputum culture showed combined infection with bacteria and fungi, sputum smear examination detected: G(+) cocci in 2 cases, and G(-) bacilli in the other 2. By using electronic fiber bronchoscopy, bronchial cast was detected in 5 patiens. Histological examination of the bronchial cast revealed a fibrinous exudation containing large quantity of eosinophils, neutrophils in 1 patients, fibrinous exudation and necrotic material containing large quantity of neutrophils in 4 patients. After the bronchial casts were removed, 4 patients were improved greatly. All patients were treated with postural drainage of left and right side position, massage of electric oscillation, strengthening the sputum suction aiming to improve pulmonary ventilation function. Three patients died: 1 case was compliicated with nephrotic syndrome, another case had congenital heart disease, and 1 case hads pneumorrhagia, renal failure and multiple organ dysfunction syndrome (MODS).

CONCLUSIONThe mortality of severe Influenza A is higher if it is complicated with underlying chronic diseases. In children undergoing rapid and progressive respiratory distress with lung atelectasis, consolidation or emphysema on chest X-ray, plastic bronchitis should be considered. Electronic fiber bronchoscopy should be performed early Lung physicotherapeutics still are important assistant measures for improving the pulmonary ventilation function.

Antiviral Agents ; therapeutic use ; Bronchitis ; diagnosis ; therapy ; virology ; Bronchoscopy ; methods ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; diagnosis ; mortality ; therapy ; Intensive Care Units ; Intubation, Intratracheal ; Male ; Oxygen Inhalation Therapy ; Pneumonia, Viral ; diagnosis ; therapy ; Pulmonary Atelectasis ; diagnosis ; therapy ; virology ; Rare Diseases ; Respiration, Artificial ; Retrospective Studies ; Sputum ; microbiology ; Treatment Outcome