Abstract
Pseudomonas and Burkholderia are gram-negative organisms that achieve colonization within the lungs of patients
with cystic fibrosis, and are associated with accelerated pulmonary function decline.
Multidrug resistance is a hallmark of these organisms, which makes eradication efforts
difficult. Furthermore, the literature has outlined increased morbidity and mortality
for lung transplant (LTx) recipients infected with these bacterial genera. Indeed,
many treatment centers have considered Burkholderia cepacia infection an absolute contraindication to LTx. Ongoing research has delineated different
species within the B. cepacia complex (BCC), with significantly varied morbidity and survival profiles. This review
considers the current evidence for LTx outcomes between the different subspecies encompassed
within these genera as well as prophylactic and management options. The availability
of meta-genomic tools will make differentiation between species within these groups
easier in the future, and will allow more evidence-based decisions to be made regarding
suitability of candidates colonized with these resistant bacteria for LTx. This review
suggests that based on the current evidence, not all species of BCC should be considered
contraindications to LTx, going forward.
Keywords
lung transplantation -
Pseudomonas
-
Burkholderia
- cystic fibrosis - sepsis
