Epidemiology of invasive fungal infections in lung transplant recipients on long‐term azole antifungal prophylaxis

Chong, Pearlie P.; Kennedy, Cassie C.; Hathcock, Matthew; Kremers, Walter K.; Razonable, Raymund R.

doi:10.1111/ctr.12516

Cited by 58 publications

(78 citation statements)

References 25 publications

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“…This association persisted when accounting for potential confounders of age, gender, single lung transplant, post‐transplant mold colonization and antifungal use. We cannot explain this association which has not been reported before and is contrary to another study which documented higher incidence of IFI among LTs with idiopathic pulmonary fibrosis …”

Section: Discussioncontrasting

confidence: 99%

“…Our IFI rates of 3.8% at 1 year, 7.6% at 3 years and 10.1% at 5 years post‐transplant were lower than other cohorts, such as one study reporting a cumulative incidence of IFI of 16%, 24% and 29% at 1, 3 and 5 years post‐transplant . LTs in this study received at least 1 year antifungal prophylaxis (predominately itraconazole) with more than 90% receiving prophylaxis indefinitely.…”

Section: Discussionmentioning

confidence: 51%

“…Invasive fungal infections (IFI) are among the commonest infections after lung transplant (LT). The reported cumulative incidence of fungal infections 1 year post‐LT varies from 8.1% to 16% . Apart from high rates of mortality such as 21.7%, all‐cause 3‐month mortality reported in a large multicenter study, fungal infections are associated with an increased risk of chronic lung allograft dysfunction .…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology of invasive fungal infections in lung transplant recipients in Western Australia

Chang

Musk

Lavender

et al. 2019

Transplant Infectious Dis

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Background Invasive fungal infections (IFI) are common after lung transplantation with reported incidence of 8.1% to 16% at 12 months post‐transplant, and 3‐month all‐cause mortality after IFI of 21.7%. Methods We performed a retrospective study of IFI and fungal colonization in lung transplants (LTs) from November 2004 to February 2017. Results 137 LTs were followed for a median 4.1 years (IQR 2.1‐6.2 years). In addition to nebulized amphotericin for the transplant admission to all LTs, systemic mold‐active azole was given to 80/130 (61.5%) LTs in the first 6 months post‐transplant, 57/121 (47.1%) in the period 6‐12 months after transplant, and 93/124 (75%) in the period more than 12 months post‐transplant. Mold airways colonization was found in 81 (59.1%) LTs before and 110 (80.3%) LTs after transplantation. There were 13 IFIs for an overall incidence of 2.1 per 100 person‐years, occurring at a median 583 days (IQR 182‐1110 days) post‐transplant, a cumulative incidence of 3.8% at 1 year, 7.6% at 3 years and 10.1% at 5 years post‐transplant. All‐cause 3‐month mortality after IFI was 7.7%. Aspergillus species followed by Scedosporium apiospermum and Cryptococcus species were the commonest fungi causing IFI. Conclusions In our cohort the rate of IFI was comparatively low, likely because of comprehensive early antifungal use and preemptive therapy at any time after transplant. Prospective studies of fungal colonization late after LT are required to determine the risks and benefits of watchful waiting compared to preemptive therapy.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 51%

Section: Introductionmentioning

confidence: 99%

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Epidemiology of invasive fungal infections in lung transplant recipients in Western Australia

Chang

Musk

Lavender

et al. 2019

Transplant Infectious Dis

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“…Voriconazole 17,25 is the most commonly used triazole, followed by itraconazole 3,5,26 and posaconazole. 18,27,28 Oral administration provides systemic antifungal concentrations that are widely distributed invarious tissues, thereby providing antifungal protection to extrapulmonary sites.…”

Section: Preventionmentioning

confidence: 99%

“…3 Up to 8.6% of patients develop invasive fungal infections during the first year after lung transplantation, although the incidence rates reported in clinical studies have varied widely depending on multiple factors, such as patient exposures, patient populations, immunosuppressive drug use, center-dependent practices (including the use of antifungal and other antibiotic prophylaxis), duration of study follow-up, and definitions of invasive fungal infection, among other factors. 3–5 …”

Section: Introductionmentioning

confidence: 99%

Fungal Infections After Lung Transplantation

Kennedy

Razonable

2017

Clinics in Chest Medicine

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The Changing Epidemiology of Invasive Fungal Infections

Enoch

Yang

Aliyu

et al. 2016

Methods in Molecular Biology

314

208

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Invasive fungal infections (IFI) are an emerging problem worldwide with invasive candidiasis and candidemia responsible for the majority of cases. This is predominantly driven by the widespread adoption of aggressive immunosuppressive therapy among certain patient populations (e.g., chemotherapy, transplants) and the increasing use of invasive devices such as central venous catheters (CVCs). The use of new immune modifying drugs has also opened up an entirely new spectrum of patients at risk of IFIs. While the epidemiology of candida infections has changed in the last decade, with a gradual shift from C. albicans to non-albicans candida (NAC) strains which may be less susceptible to azoles, these changes vary between hospitals and regions depending on the type of population risk factors and antifungal use. In certain parts of the world, the incidence of IFI is strongly linked to the prevalence of other disease conditions and the ecological niche for the organism; for instance cryptococcal and pneumocystis infections are particularly common in areas with a high prevalence of HIV disease. Poorly controlled diabetes is a major risk factor for invasive mould infections. Environmental factors and trauma also play a unique role in the epidemiology of mould infections, with well-described hospital outbreaks linked to the use of contaminated instruments and devices. Blastomycosis is associated with occupational exposure (e.g., forest rangers) and recreational activities (e.g., camping and fishing).The true burden of IFI is probably an underestimate because of the absence of reliable diagnostics and lack of universal application. For example, the sensitivity of most blood culture systems for detecting candida is typically 50 %. The advent of new technology including molecular techniques such as 18S ribosomal RNA PCR and genome sequencing is leading to an improved understanding of the epidemiology of the less common mould and dimorphic fungal infections. Molecular techniques are also providing a platform for improved diagnosis and management of IFI.Many factors affect mortality in IFI, not least the underlying medical condition, choice of therapy, and the ability to achieve early source control. For instance, mortality due to pneumocystis pneumonia in HIV-seronegative individuals is now higher than in seropositive patients. Of significant concern is the progressive increase in resistance to azoles and echinocandins among candida isolates, which appears to worsen the already significant mortality associated with invasive candidiasis. Mortality with mould infections approaches 50 % in most studies and varies depending on the site, underlying disease and the use of antifungal agents such as echinocandins and voriconazole. Nevertheless, mortality for most IFIs has generally fallen with advances in medical technology, improved care of CVCs, improved diagnostics, and more effective preemptive therapy and prophylaxis.

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Epidemiology of invasive fungal infections in lung transplant recipients on long‐term azole antifungal prophylaxis

Cited by 58 publications

References 25 publications

Epidemiology of invasive fungal infections in lung transplant recipients in Western Australia

Epidemiology of invasive fungal infections in lung transplant recipients in Western Australia

Fungal Infections After Lung Transplantation

The Changing Epidemiology of Invasive Fungal Infections

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