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KMID : 0604020150300020103
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Korean Journal of Critical Care Medicine
2015 Volume.30 No. 2 p.103 ~ p.108
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Lung Transplantation in a Patient with Pre-transplant Colonization of Extensively Drug-resistant Acinetobacter baumannii
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Lee Hwa-Young
Lee Hea-Yon
Shin Sae-Bom
Shin Kab-Soo
Lee Bong-Woo
Kim Hwan-Wook
Lee Seok
Kim Seok-Chan
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Abstract
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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. Wereport a case of extensively drug resistant (XDR) A. baumannii colonization in the tracheobronchial tree that caused severe infectiouscomplications after bilateral lung transplantation. A 23-year-old man diagnosed with bronchiolitis obliterans syndrome (BOS) 4 yearsearlier with a history of allogenic bone marrow transplantation for acute lymphoblastic leukemia was admitted to the hospital withdyspnea. Due to progressive hypercapnic respiratory failure, long-term mechanical ventilation was started after a tracheostomy wasperformed, and the patient underwent a bilateral lung transplantation to treat end-stage BOS. After the transplantation, the colonizationof XDR A. baumannii caused severe bacterial pneumonia in the early postoperative period. Combined treatment with colistin andmeropenem led to recovery from the pneumonia but caused drug-induced renal failure. Because many centers are willing to transplantcandidates who are on mechanical ventilation or extracorporeal life support, the incidence of XDR A. baumannii colonization ofpretransplant lungs is expected to increase. Further studies are needed to examine pre-transplant management strategies in patientscolonized with XDR A. baumannii.
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KEYWORD
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Acinetobacter baumannii, drug resistance, lung transplantation
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