Epidemiological features of invasive mold infections among solid organ transplant recipients: PATH Alliance^®registry analysis

Abstract

Epidemiological characteristics of 333 proven and probable invasive mould infections (IMIs) among solid organ transplant recipients (SOTRs) identified between 2004 and 2008 from the Prospective Antifungal Therapy Alliance (PATH) registry are presented. Liver transplant recipients (LTRs) had the lowest median time to IMIs (109 days; interquartile range [IQR] 24-611 days), the highest rate of disseminated disease (n/N = 18/33; 55%), and highest mortality (n/N = 21/33; 64%). Lung transplant recipients had highest median time to IMIs (486 days; IQR 117-1358 days) and lowest mortality (n/N = 31/184; 17%). Complete or partial response at week 12 in patients with invasive aspergillosis (IA) was 67% (n/N = 189/281), and 41% (n/N = 9/22) in mucormycosis patients. In the composite outcome of death or no response to therapy, LTRs had the worst outcome. Higher suspicion of mold infection and institution of appropriate antifungal prophylactic strategies are warranted, especially in high risk LTRs.

A Multidisciplinary Approach to Pretransplant and Posttransplant Management of Cystic Fibrosis–Associated Liver Disease

“…(79) To improve the yield of NTM, decontamination of respiratory cultures is needed to avoid overgrowth of the specimens by bacteria, such as Pseudomonas . (25) BAL specimens every 3 months to enhance the yield of microorganisms, particularly from patients who do not spontaneously produce sputum, are consistent with recommended routine CF care for older children and adults. (18,80) In addition, it is prudent to perform quarterly cultures for NTM following LT.…”

“…Most centers will not transplant individuals with CF who have recurrent pulmonary exacerbations associated with multidrug resistant (MDR) pathogens for which limited or no therapeutic options are available and are associated with early mortality, such as Burkholderia cepacia complex (specifically strains of Burkholderia cenocepacia ) and Mycobacterium abscessus . Fungal and mold infections are associated with the highest mortality risks in LT recipients with invasive aspergillosis associated with a 61% mortality rate at 12 months after LT . Centers lacking infectious disease consultation with CF expertise should initiate outpatient referral or transfer to centers with such expertise if LT is being considered.…”

Outcomes of solid organ transplant recipients with invasive aspergillosis and other mold infections

“…Hemodynamic failure is frequently related to concomitant bacterial infection . In our series, a concomitant infection was identified in 54% of patients, a prevalence close to the one reported by Husain et al, underlying the need for in‐depth infection screening in SOT recipients with invasive aspergillosis. All the patients with concomitant infection had invasive aspergillosis, contrasting with none in the patients with other IMI.…”

Cytokine profile in lung transplant recipients with Aspergillus spp colonization

“…Among the non‐CMV infections, fungal infections remain one of the main causes of morbidity and mortality inLTRs and are associated with a higher mortality compared to bacterial or viral infections . Aspergillus spp is the most common cause of invasive fungal infection in this setting, leading to invasive pulmonary aspergillosis (IPA) in 5%‐19% of patients, and resulting in a mortality rate of 22.1% . There are several approaches to prevent these fungal infections including: universal prophylaxis, pre‐emptive treatment, and targeted treatment.…”