Epidemiology of invasive fungal infections in lung transplant recipients on long‐term azole antifungal prophylaxis
- 12 February 2015
- journal article
- clinical trial
- Published by Wiley in Clinical Transplantation
- Vol. 29 (4), 311-318
- https://doi.org/10.1111/ctr.12516
Abstract
Lung transplant recipients (LTR) at our institution receive prolonged and mostly lifelong azole antifungal (AF) prophylaxis. The impact of this prophylactic strategy on the epidemiology and outcome of invasive fungal infections (IFI) is unknown. This was a single-center, retrospective cohort study. We reviewed the medical records of all adult LTR from January 2002 to December 2011. Overall, 16.5% (15 of 91) of patients who underwent lung transplantation during this time period developed IFI. Nineteen IFI episodes were identified (eight proven, 11 probable), 89% (17 of 19) of which developed during AF prophylaxis. LTR with idiopathic pulmonary fibrosis were more likely to develop IFI (HR: 4.29; 95% CI: 1.15-15.91; p = 0.03). A higher hazard of mortality was observed among those who developed IFI, although this was not statistically significant (hazard ratio [HR]: 1.71; 95% confidence interval [CI] [0.58-4.05]; p = 0.27). Aspergillus fumigatus was the most common cause of IFI (45%), with pulmonary parenchyma being the most common site of infection. None of our patients developed disseminated invasive aspergillosis, cryptococcal or endemic fungal infections. IFI continue to occur in LTR, and the eradication of IFI appears to be challenging even with prolonged prophylaxis. Azole resistance is uncommon despite prolonged AF exposure.Keywords
This publication has 24 references indexed in Scilit:
- OPTN/SRTR 2011 Annual Data Report: LungAmerican Journal of Transplantation, 2012
- The Registry of the International Society for Heart and Lung Transplantation: 29th Adult Lung and Heart-Lung Transplant Report—2012The Journal of Heart and Lung Transplantation, 2012
- A Targeted Peritransplant Antifungal Strategy for the Prevention of Invasive Fungal Disease After Lung TransplantationTransplantation, 2012
- Antifungal Prophylaxis in Lung Transplantation—A World-wide SurveyAmerican Journal of Transplantation, 2011
- The impact of invasive fungal diseases on survival after lung transplantationClinical Transplantation, 2010
- Antifungal Prophylaxis with Voriconazole or Itraconazole in Lung Transplant Recipients: Hepatotoxicity and EffectivenessAmerican Journal of Transplantation, 2009
- Revised Definitions of Invasive Fungal Disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus GroupClinical Infectious Diseases, 2008
- Revision of the 1996 Working Formulation for the Standardization of Nomenclature in the Diagnosis of Lung RejectionThe Journal of Heart and Lung Transplantation, 2007
- Voriconazole Prophylaxis in Lung Transplant RecipientsAmerican Journal of Transplantation, 2006
- The incidence of invasive aspergillosis among solid organ transplant recipients and implications for prophylaxis in lung transplantsTransplant Infectious Disease, 2002