What is the role of antimicrobial therapy following lung transplantation?

Updated: Aug 19, 2019
  • Author: Bryan A Whitson, MD, PhD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Answer

Bacterial prophylaxis against gram-positive organisms and a broad-spectrum antibiotic for the organisms identified preoperatively should be administered. Patients with cystic fibrosis require coverage for pseudomonal species, usually with antipseudomonal cephalosporin. These antibiotics can be tailored depending on the donor and recipient cultures collected at the time of transplantation.

Routine prophylaxis for fungal organisms is useful when the recipient's sputum cultures show the presence of Aspergillus.Herpes simplex infections have been eliminated by routine acyclovir prophylaxis after lung transplantation. Cytomegalovirus (CMV) infection remains a significant problem following lung transplantation. The incidence of CMV infection after lung transplantation is related to the preoperative CMV status of both the donor and the recipient. The use of ganciclovir prophylaxis has reduced the incidence of primary disease significantly and has improved outcome. Pneumocystis jiroveci infection has been eliminated by the routine use of trimethoprim-sulfamethoxazole, which is administered three times per week following surgery.


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