*Purpose: In lung transplant recipients Mycoplasma hominis and Ureaplasma spp. may cause localized or disseminated infection and fatal hyperammonemia syndrome (HS). Optimal prevention strategies are not known. We aimed to evaluate the outcome of routine screening at our institution.

*Methods: We retrospectively reviewed records of all lung transplant recipients at our multisite institution from 01/01/2015 to 11/15/2019. M. hominis and U. urealyticum/parvum PCR were performed on pre-transplant recipient urine and donor bronchial swab at transplantation. If positive PCR was identified, antibiotic treatment and duration were recorded. Outcomes included development of Mycoplasma or Ureaplasma infection and HS.

*Results: A total of 268 patients underwent lung transplantation during the study period. Of these, 11/115 (9.6%) screened positive. 9 were donor positive, 1 was recipient positive and 1 was both. Majority of positive donors were female (6/10; 60.7%). Median age of donors was 22 years (IQR 18-29). Among donors, 4 were positive for M. hominis, U. urealyticum, and U. parvum each. 2 donors were positive with more than one test. Prophylaxis was administered with doxycycline, levofloxacin or azithromycin. Duration of treatment varied from 1 week to 12 weeks (Table 1). One patient developed M. hominis mediastinitis after completing combined prophylaxis with levofloxacin and doxycycline (pt. #4, Table 1). Testing showed an M. hominis isolate that was susceptible to levofloxacin and tetracycline. Another patient developed HS (altered mental status and ammonia of >100 mcg/dL) after treatment with 2 weeks of doxycycline and levofloxacin (pt. #10, Table 1). In two other patients, ammonia was slightly higher than reference range but neither developed HS infection. One patient developed M. hominis mediastinitis two weeks after transplantation despite negative screening test results. No deaths were related to mollicute.

*Conclusions: Donor-derived Mycoplasma and Ureaplasma spp infection is more common than recipient-derived infection. Despite prophylaxis, local infection and HS may still occur. Larger studies are needed to determine the appropriate antibiotic choice as well as duration and effectiveness of prophylaxis.

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