Candidemia in solid organ transplant recipients in Spain: Epidemiological trends and determinants of outcome

Abstract

Other members of the CANDIPOP Project and the CANDI-Bundle Group are listed in the Acknowledgements section. AbstractBackground: Despite being considered a high-risk population for invasive fungal disease, specific features of candidemia among solid organ transplant (SOT) recipients remain poorly characterized. Methods:We compiled prospective data from two multicenter studies on candidemia performed over two consecutive periods in Spain: the CANDIPOP Study (2010)(2011) and the CANDI-Bundle Study (2016)(2017)(2018). Episodes diagnosed in adult SOT recipients in 10 participating centers were included. Risk factors for clinical failure (all-cause 7-day mortality and/or persistent candidemia for ≥72 hours) and 30-day mortality were investigated by univariate analysis. Results:We included 55 episodes of post-transplant candidemia (32 and 23 of which occurred during the first and second periods). Kidney (38.2%) and liver recipients (30.9%)

Fungal Infections in Liver Transplant Recipients

“…Over time, there has been a trend toward infection with non- albicans species. For instance, a Spanish cohort examining candidemia over time in solid organ transplant recipients (SOTRs), comparing 2010–2011 with 2016–2018, showed an increase in C. glabrata over time from 18.8% to 30.4% and a decrease in C. albicans cases over that period [ 9 ]. Further, there has been suggestion of higher mortality with non- albicans species.…”

Mucosal Bacteria Modulate Candida albicans Virulence in Oropharyngeal Candidiasis

“…Oropharyngeal candidiasis (OPC) is the most prevalent fungal infection in patients with immature or weakened immune systems, such as neonates ( 1 ), HIV + patients ( 2 , 3 ), patients undergoing intensive cancer chemotherapy ( 4 ), and transplant recipients who rely on pharmacological immunosuppression to avoid organ rejection ( 5 , 6 ). These patients are susceptible to Candida bloodstream infection, a severe infection with mortality as high as 27% ( 7 , 8 ).…”

Rectal screening for azole non‐susceptible Candida species in patients undergoing liver transplantation

“…primary LTs and two re-transplantations (Table 1 Invasive candidiasis is an important source of morbidity and mortality in SOT recipients, and ANSC infections are increasingly reported. 1,3,8 In a multicenter, randomized, double-blind trial among LT recipients, antifungal prophylaxis with echinocandins was associated with similar efficacy for preventing invasive candidiasis as fluconazole prophylaxis. 10 However, the choice of antifungal prophylaxis in this trial was not tailored to the individual patient's flora.…”

“…[4][5][6][7] In recent years, non-albicans Candida spp. have emerged in SOT recipients, 1,3,8 and their resistance patterns likely impact the efficacy of antifungal prophylaxis. We hypothesized that pre-transplant screening for azole non-susceptible Candida (ANSC) allows for tailored antifungal prophylaxis to reduce the incidence of post-LT ANSC infection.…”