Epidemiology of candidemia in lung transplant recipients and risk factors for candidemia in the early posttransplant period in the absence of universal antifungal prophylaxis

Abstract

Background: Lung transplant recipients are at increased risk of candidemia, especially in the early posttransplant period. However, the specific predisposing factors have not been established. The natural history of candidemia after lung transplantation, in the absence of universal antifungal prophylaxis, is not known. Methods:We retrospectively examined the epidemiology of candidemia at any time posttransplant in patients who underwent lung transplantation at our center between 2016 and 2019. We undertook a case-control study and used logistic regression to evaluate the risk factors for candidemia during the first 30 days posttransplantation. Results: During the study period 712 lung transplants were performed on 705 patients. Twenty-five lung transplant recipients (LTRs) (3.5%) experienced 31 episodes of candidemia. The median time to candidemia was 19.5 days (IQR 10.5-70.5), with 61.2% (n = 19) episodes of candidemia occurring within the first 30 days posttransplantation.Pretransplant hospitalization, posttransplant ECMO, and posttransplant renal replacement therapy were associated with an increased risk of candidemia in the first 30 days posttransplant. Of those with candidemia in the first 30 days, 31.2% died within 30 days of the index positive blood culture. Candidemia was associated with decreased survival within 30 days posttransplant. Conclusion:This study highlights the greatest risk period of lung transplant recipients for development of candidemia and identifies several factors associated with increased risk of candidemia. These findings will help guide future studies on antifungal prophylaxis.

Candidemia in thoracic solid organ transplant recipients: Characteristics and outcomes relative to matched uninfected and bacteremic thoracic organ transplant recipients

“…19,21 Renal replacement therapy and temporary mechanical circulatory support post-transplant were also associated with candidemia in our heart recipients, consistent with prior reports. 22 Both renal replacement therapy and temporary mechanical circulatory support require ongoing central venous access, likely placing patients at risk for endovascular infections.…”

Risk Factors for Early Fungal Disease in Solid Organ Transplant Recipients: A Systematic Review and Meta-analysis

“…Likewise, posttransplant characteristics including reoperation (OR, 2.92; CI, 1.79-4.75), 22,23,[28][29][30]32,35,37,42,69,70 posttransplant renal replacement therapy (OR, 2.91; CI, 1.87-4.51), 22,24,26,[28][29][30][31]34,35,37,41,69,70,78,81 cytomegalovirus (CMV) disease (OR, 2.97; CI, 1.78-4.94), 22,26,30,34,37,39,40 and primary graft dysfunction (OR, 1.96; CI, 1.12-3.42) 29,[39][40][41]78 were associated with any early IFI. Of all the aforementioned risk factors, only reoperation, posttransplant renal replacement therapy, and CMV disease had high-certainty evidence.…”

“…The only significant risk factor identified in this study was steroid use within the 30 d preceding transplant. 61 Marinelli et al 69 looked at risk factors for candidemia in lung transplant recipients only. While this study did not specifically evaluate pretransplant steroids use, they found pretransplant hospitalization (OR, 5.8; CI, 1.1-30.9) and posttransplant ECMO support (OR, 11.6; CI, 1.4-95.2) and renal replacement therapy (OR, 16.9; CI, 2.1-137.9) to be significant risk factors for IC on multivariable modeling.…”

“…Table 1 summarizes key study characteristics. Topically, 20 studies pertained to liver transplant, [27][28][29][30][31][32][33][34][35][36][52][53][54][55][56][57][58][59]77,78 15 to lung transplant, 5, [38][39][40][41][64][65][66][67]69,71,72,[74][75][76] 9 to kidney transplant, 25,26,[46][47][48][49][50][51]73 6 to heart transplant, [22][23][24][43][44][45] 1 to small bowel transplant, 68 2 to pancreas-kidney tr...…”

Recurrent Candidemia Due to Extracorporeal Membrane Oxygenation Circuit Seeding in Acute Respiratory Distress Syndrome From COVID-19

“…1 Candida bloodstream infection specifically is associated with poor outcomes in acute respiratory distress syndrome (ARDS) patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) and in lung-transplant recipients. 2,3 Here, we present a case of a 27-year-old man who transferred to be evaluated for lung transplantation in November 2021 and developed recurrent candidemia. He initially presented to an outside hospital with COVID-19 that September, developed ARDS, and was placed on VV-ECMO 5 days after intubation.…”