Prevalence and management of gastrointestinal complications in lung transplant patients: MITOS study group.

INTRODUCTION: No studies have yet been performed to evaluate the prevalence of gastrointestinal (GI) complications in solid organ transplant recipients in Spain. MATERIALS AND METHODS: An observational, cross-sectional study to evaluate the prevalence and management of GI complications in transplanted patients was conducted via a written questionnaire given to doctors at their practice. RESULTS: A total of 58 lung transplant recipients were included. Their mean age was 52.6 +/- 10.8 years; 65% of the patients were men; and the mean time since the transplant was 2.1 +/- 2.3 years. GI complications were seen in 48.6% of the lung transplant patients. Regarding the management, the most frequently used measure was the prescription of gastric protectors (70.5%). In seven patients, the immunosuppressive treatment was also modified (reduced, discontinued temporarily, or discontinued permanently); however, the figure is so low that no conclusions can be drawn from this result. CONCLUSIONS: The prevalence of GI complications in lung transplant was over 50%, and these complications affected patients' daily activities in most cases. In lung transplant recipients, there was a higher prevalence of nausea and abdominal pain and a lower of diarrhea and dyspepsia than what was observed in other type of transplant recipients.

13--Antibiotic therapy of community-acquired pneumonia (CAP) caused by atypical agents.

Macrolides, fluoroquinolones, doxycycline, and ketolides show a good intrinsic activity against intracellular pathogens which are responsible for a variable percentage of community-acquired pneumonia (CAP). These therapeutic agents all seem effective in treating most cases of CAP caused by Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella spp. Among quinolones, the more recent fluoroquinolones, such as gemifloxacin or moxifloxacin, generally show a better intrinsic activity than the older ones. Among macrolides, azithromycin, and clarithromycin show a better pharmacokinetic profile. Both of them are available in intravenous form. It is quite common for M. pneumoniae and C. pneumoniae to continue to be shed in respiratory secretions, weeks after an effective therapy. The clinical relevance of this finding is not clear since most of these patients have a good outcome. Azithromycin, due to its advantageous pharmacokinetic profile, seems the best option when antibiotic prophylaxis is considered in some epidemiological settings. It has been proved effective in closed M. pneumoniae outbreaks.

Preemptive therapy with intravenous ganciclovir for the prevention of cytomegalovirus disease in lung transplant recipients.

The most effective strategy for the prevention of cytomegalovirus (CMV) disease in lung transplantation has not been conclusively established. The aim of this study was to determine the efficacy of preemptive ganciclovir therapy for this purpose. Twenty-five consecutive adult patients positive for CMV before transplantation and surviving more than 30 days after the procedure were studied. Mean follow-up was 732.2 days (range, 210-1125). All patients received intravenous (IV) ganciclovir prophylaxis for the first 21 days and subsequently underwent frequent CMV antigenemia monitoring: weekly for the first 3 months, every 15 days between 3 and 6 months, and monthly thereafter. IV ganciclovir was given when antigenemia results were greater than 10 infected cells per 100,000 polymorphonuclears. The study group was compared with a historical group of 30 consecutive patients who had received IV ganciclovir prophylaxis and continued on oral ganciclovir up to day 120 posttransplantation. Eighteen of the 25 patients (72.0%) presented episodes of CMV infection. Six of the 25 patients (24.0%) had CMV disease, including 3 viral syndromes and 3 cases of pneumonitis. Four patients debuted with CMV disease, 1 of them with pneumonitis. CMV resistance to ganciclovir was observed in 2 patients. The incidence of infection was higher than in the historical group (72.0% vs 46.7%; P < .05), but there were no significant differences in the incidence of CMV disease (24.0% vs 40.0%; P = not significant [NS]). Mean time before onset of the first episode of disease was lower in the preemptive therapy group than in the comparison patients (82.8 days; range, 42-240 vs 175 days; range, 90-243; P < .05). In conclusion, preemptive therapy for CMV disease is as effective a prevention strategy as oral ganciclovir prophylaxis. However, the early appearance of CMV disease with preemptive therapy can make this approach inadvisable.