• Oana Joean, Laura Petra von Eynern, Tobias Welte, Gunilla Einecke, Sabine Dettmer, Jan Fuge, Richard Taubert, Heiner Wedemeyer, and Jessica Rademacher.
• Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany. Electronic address: oana.joean@gmail.com.
• Chest. 2024 Oct 1; 166 (4): 697707697-707.

BackgroundCommunity-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Limited evidence is available on the most effective diagnostic approaches, management strategies, and long-term outcomes for CAP in patients who have undergone solid organ transplantation.Research QuestionWhat is the acute and long-term morbidity and mortality after CAP in organ transplant recipients?Study Design And MethodsWe retrospectively analyzed hospitalizations for CAP in solid organ recipients at the largest German transplant center. The study included patients admitted between January 1, 2010, and May 31, 2021. The reported outcomes are in-hospital and 1-year mortality, risk of cardiovascular events during hospitalization and at 1 year, admission to the ICU, and risk of pneumonia with Pseudomonas aeruginosa. Multivariable binary logistic regression using stepwise forward selection was performed to determine predictive factors for pneumonia with P aeruginosa.ResultsWe analyzed data from 403 hospitalizations of 333 solid organ recipients. In > 60% of cases, patients had multiple comorbidities, with cardiovascular and chronic kidney disease being the most prevalent. More than one-half of the patients required oxygen supplementation after admission. In-hospital mortality (13.2%) and the death rate at 1 year postevent (24.6%) were higher than data reported from immunocompetent patients. We also observed high rates of acute cardiovascular events and events occurring 1 year after admission. Early blood cultures and bronchoscopy in the first 24 h significantly increased the odds of establishing an etiology. In our low-resistance setting, the burden of antimicrobial resistance was driven by bacteria from chronically colonized patients, mostly lung transplant recipients.InterpretationThis comprehensive analysis highlights the high morbidity associated with CAP after transplantation. It also emphasizes the need for prospective multicenter studies to guide evidence-based practices and improve outcomes for these vulnerable patients.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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