Comparison of Infectious Pathogen Detection in Pre and Postmortem Specimens from Lung Transplant Patients.
Zhihong Hu, Yanxia Li, James Gagermeier, Charles G Alex, Robert Love, Maria M Picken. Loyola University Medical Center, Maywood, IL
Background: Infection/sepsis remains a major cause of death post lung tx. Various methods, including transbronchial (tx), play pivotal roles in evaluating infection post lung tx. At autopsy, lung tissue is often cultured to detect infection. However, the consistency and value of these premortem and postmortem methods are still unclear.
Design: 76 lung tx patients, autopsied in the past 2 decades, were retrospectively compared with regard to premortem and autopsy findings on the detection of various infectious pathogens.
Results: Of 76 lung tx patients, 46 pts died of infection/sepsis post tx, caused by bacteria/virus/fungus. CMV was the main viral pathogen. 21 pts were CMV (+) by premortem PCR/culture/BAL/transbronchial bx. 17 were detected at autopsy, with a consistency of 76%. Aspergillus/Candida were the main fungal pathogens. 6 cases of Aspergillus infection were identified premortem by lung bx/culture, which was 100% consistent with autopsy findings. However, none of the 7 cases with Candida infection diagnosed premortem was identified at autopsy. Pseudomonas was the main bacterial pathogen, both premortem and at autopsy. 23 patients were detected with bacterial infection/sepsis by premortem blood/sputum/urine culture, while 26 were found at autopsy by lung tissue culture. Among these patients, 12 had a (+) premortem bacterial culture, consistent with autopsy (52%). However, 11 cases with a (+) premortem bacterial culture were not identified at autopsy, and 24 cases with a (+) bacterial culture at autopsy were not detected premortem.
Conclusions: Premortem and autopsy findings showed different consistencies in detecting various pathogens. Aspergillus and CMV were most consistently detected. In contrast, bacteria showed a low consistency rate, which may be due to therapeutic intervention, contamination, or the inaccuracy of the techniques used.
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 234, Monday Morning