*Purpose: The purpose of this study is to determine the differences in clinical outcomes of culture-positive pneumonia in solid organ transplant (SOT) recipients compared to non-SOT patients.

*Methods: This retrospective cohort study included adult inpatients with positive bronchoalveolar lavage (BAL) or sputum cultures. SOT patients were matched 1:2 to non-SOT patients based on age and gender. The primary outcome was in-hospital mortality. Secondary outcomes included 90-day mortality, time-to-appropriate antibiotics, antibiotic duration, days on ventilator, hospital length of stay (LOS), and hospital readmission.

*Results: This study included 73 SOT and 146 matched non-SOT patients. The average age was 54.7 years; 67.6% were male. The majority were Caucasian (87.7% vs 82.2%, p=0.3). Of the SOT patients, the majority were kidney (30.1%) and liver (20.6%) recipients. Average time post-transplant was 6.4±8 years. Regarding baseline characteristics, SOT recipients were more likely to have hypertension (72.6% vs 58.2%, p=0.04), diabetes (43.8% vs 29.5%, p=0.03), and end-stage renal disease (12.3% vs 0.7%, p=0.0001). In-hospital mortality for SOT recipients was not statistically significantly different compared to non-SOT (27.4% vs 18.5%, p=0.13). Hospital LOS was longer for SOT recipients (34.9 vs 25.3 days, p=0.03) and time to readmission was shorter (19.6 vs 26.6 days, p=0.03). Other secondary outcomes were similar between groups. In terms of cultures, SOT recipients were more likely to have BAL cultures (42.5% vs 28.1%, p=0.03). The most common organisms were Pseudomonas aeruginosa (31.5% vs 23.3%, p=0.09), Methicillin-sensitive Staphylococcus aureus (9.6% vs 22.6%, p=0.045), Methicillin-resistant S. aureus (13% vs 13.7%, p=0.68), Klebsiella pneumonia (6.8% vs 11%, p=0.45), and Escherichia coli (9.6% vs 8.9%, p=0.69). The most common initial and appropriate antibiotics were vancomycin, piperacillin-tazobactam, and cefepime. Combination antibiotics were initiated in most patients (64.4 vs 63.7%, p=0.92). Appropriate antibiotic duration was similar (9.1 vs 13.2 days, p=0.31), but SOT recipients were more likely to not receive appropriate antibiotics (21.9% vs 11.6%, p=0.03).

*Conclusions: In-hospital mortality in SOT recipients was not significantly different from that in non-SOT patients. SOT recipients had a significantly longer hospital LOS, shorter time to readmission and were less likely to receive appropriate antibiotics.

« Back to 2021 American Transplant Congress