Pneumonia in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

被引:47
作者
Dulek, Daniel E. [1 ]
Mueller, Nicolas J. [2 ,3 ]
机构
[1] Vanderbilt Univ, Med Ctr, Div Pediat Infect Dis, Nashville, TN USA
[2] Univ Hosp Zurich, Div Infect Dis, Zurich, Switzerland
[3] Univ Hosp Zurich, Hosp Epidemiol, Zurich, Switzerland
关键词
diagnosis; pneumonia; transplantation; INVASIVE FUNGAL-INFECTIONS; BRONCHOALVEOLAR LAVAGE GALACTOMANNAN; RESPIRATORY VIRAL-INFECTIONS; CLINICAL-PRACTICE GUIDELINES; ACQUIRED PNEUMONIA; RISK-FACTORS; REQUIRING HOSPITALIZATION; IMMUNOSUPPRESSED PATIENTS; PULMONARY ASPERGILLOSIS; KIDNEY-TRANSPLANTATION;
D O I
10.1111/ctr.13545
中图分类号
R61 [外科手术学];
学科分类号
摘要
These guidelines from the AST Infectious Diseases Community of Practice review the diagnosis and management of pneumonia in the post-transplant period. Clinical presentations and differential diagnosis for pneumonia in the solid organ transplant recipient are reviewed. A two-tier approach is proposed based on the net state of immunosuppression and the severity of presentation. With a lower risk of opportunistic, hospital-acquired, or exposure-specific pathogens and a non-severe presentation, empirical therapy may be initiated under close clinical observation. In all other patients, or those not responding to the initial therapy, a more aggressive diagnostic approach including sampling of tissue for microbiological and pathological testing is warranted. Given the broad range of potential pathogens, a microbiological diagnosis is often key for optimal care. Given the limited literature comparatively evaluating diagnostic approaches to pneumonia in the solid organ transplant recipient, much of the proposed diagnostic algorithm reflects clinical experience rather than evidence-based data. It should serve as a template which may be modified according to local needs. The same holds true for the suggested empiric therapies, which need to be adapted to the local resistance patterns. Further study is needed to comparatively evaluate diagnostic and empiric treatment strategies in SOT recipients.
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页数:11
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