To summarize and analyze the clinical characteristics and prognosis of early infection after lung transplantation.

A retrospective analysis of the clinical data of 30 lung transplant recipients from October 2015 to January 2018 in the Department of Lung Transplant of Henan Provincial People′s Hospital was conducted. The donor lungs were harvested from 27 donors (donation after cardiac death). Among the 30 lung transplant recipients, 2 had double-lung transplant and 28 had single-lung transplant. The recipients were given imipenem and cilastatin during transplantation, and imipenem and cilastatin, caspofungin, ganciclovir were used to prevent infection after transplantation. The postoperative immunosuppressive regimen inclued tacrolimus, mycophenolate mofetil and prednisone. During the hospitalization period, the recipients had routine chest X-ray or chest CT, bronchoscopy and pathogenic monitoring and so on. The recipients were follow-up every 1 to 2 weeks within 3 months after transplantation.

Two donor lungs had positive outcomes of airway secretions microbiology test, 1 was considered to be infected by nontuberculous mycobacteria. Within 30 days after transplantation, the incidence of infection was 73.3% (22/30), 22 recipients had 24 cases of bacterial infection (21 cases of respiratory system infection and 3 cases of bloodstream infection). Respiratory system infection included 9 cases of airway infection, 9 cases of airway infection combined with invasive lung infection, and 3 cases of pleural cavity infection. Among respiratory system infection, 16 cases were caused by single pathogen and 5 were caused by multiple pathogens. A total of 26 strains of pathogens were isolated from respiratory system infection: 10 strains of Acinetobacter baumanii (8 strains were pan-resistant), 5 strains of carbapenem-resistant Klebsiella pneumoniae, and 3 strains of Pseudomonas aeruginosa (2 strains were Pan-resistant), 2 strains of pan-resistant Stenotrophomonas maltophilia, 2 strains of pan-resistant Corynebacterium striatum, and 1 each of Serratia marcescens, Enterobacter cloacae, methicillin resistant Staphylococcus aureus and Nontuberculous mycobacteria. Three cases of bloodstream infection were caused by carbapenem-resistant Klebsiella pneumoniae (2 cases) and Flavobacterium meningitidis (1 case). Among 21 cases of respiratory system bacterial infection, 3 cases of fungal infection were considered. Ten recipients infected with Acinetobacter baumanii were treated with anti-microbial treatments, the infection was controlled in 7 recipients; the remaining 3 recipients died on the 40th, 45th and 60th day after transplantation. After anti-microbial treatments, 4 in 5 recipients infected with carbapenem-resistant Klebsiella pneumoniae were controlled, and 1 died on the 50th day after transplantation. Follow-up as of July 2019, 9 recipients died, the sruvivers have normal daily life.

The most common infections in the early period after lung transplantation were airway infection and invasive infection. The most common pathogens were pan-resistant or multi-resistant gram negative bacilli.