Fungal infection in lung transplant recipients in perioperative period from one lung transplant center

Abstract

Background: This study aimed to analyze the distribution and prophylaxis strategy of pathogens causing fungal infection in lung transplant recipients from cardiac-brain dead donors in the perioperative period to provide evidence for antifungal prophylaxis and treatment in lung transplant recipients. Methods: This retrospective study evaluated 194 lung transplant recipients from January 2015 to December 2016. Fungal pathogens were isolated and identified from respiratory tract cultures before and after transplantation in the perioperative period. The galactomannan (GM) testing of bronchoalveolar lavage fluid (BALF) might facilitate the diagnosis of Aspergillus infection. Data were statistically analyzed using SPSS 19.0. Results: A total of 31 cases of fungal strains isolated from the 194 recipients were identified prior to lung transplantation, and the positive rate was 16.0% (31/194). A total of 27 cases of isolated fungal strains in the 194 recipients were identified, and the positive rate after lung transplantation was 13.9% (27/194) in the perioperative period. A total of 54 cases with positive fungal infection (27.8%) were detected before and after lung transplantation. Overall, 10.3% (20/194) of the lung transplant recipients developed fungal infection in the observation period. The most common fungal pathogens were filamentous fungi and Candida albicans. Conclusions: Our data suggested that fungi were frequently isolated before and after transplantation from respiratory samples. However, the incidence of invasive fungal infection in lung transplant recipients in the perioperative period was relatively low. Targeted antifungal prophylaxis and treatment should be applied on the basis of the fungal distribution status of different individuals.

Population Pharmacokinetics of Caspofungin among Extracorporeal Membrane Oxygenation Patients during the Postoperative Period of Lung Transplantation

“…In our center, we use a combination of intravenous triazoles and inhaled amphotericin B for targeted prophylaxis in patients with a high risk of invasive fungal infections, such as patients with cystic fibrosis and/or fungal colonization of the airways. In patients without high-risk factors, triazole can be replaced by caspofungin for universal antifungal prophylaxis because of its lower toxicity, slight interaction with immunosuppressive drugs, and broad-spectrum activity against most Candida species ( 5 ), which account for the majority (43 to 80%) of the fungal infections occurring within 1 month of lung transplantation ( 6 , 7 ).…”

Clinical Characteristics, Quality of Life, and Risk Factors of Amputation Stump Skin Disease and Stump Fungal Infection in Adult Amputees in Shanghai, China

“…Meanwhile, all the specimens were inoculated in Sabouraud’s dextrose agar medium and incubated at 28°C for two weeks to identify the fungal species. The species were verified based on morphological characteristics and biochemical test methods by using standard taxonomic keys ( Qiao et al, 2019 ).…”

Factors affecting complications development and mortality after single lung transplant

“…In the perioperative phase, however, invasive fungal infection in lung transplant recipients was comparatively low. Antifungal prophylaxis and care should be tailored to the fungal dissemination status of each organism[ 63 ].…”