1
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Pennington KM, Martin MJ, Murad MH, Sanborn D, Saddoughi SA, Gerberi D, Peters SG, Razonable RR, Kennedy CC. Risk Factors for Early Fungal Disease in Solid Organ Transplant Recipients: A Systematic Review and Meta-analysis. Transplantation 2024; 108:970-984. [PMID: 37953478 DOI: 10.1097/tp.0000000000004871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Invasive fungal infections are associated with high morbidity in solid organ transplant recipients. Risk factor modification may help with preventative efforts. The objective of this study was to identify risk factors for the development of fungal infections within the first year following solid organ transplant. METHODS We searched for eligible articles through February 3, 2023. Studies published after January 1, 2001, that pertained to risk factors for development of invasive fungal infections in solid organ transplant were reviewed for inclusion. Of 3087 articles screened, 58 were included. Meta-analysis was conducted using a random-effects model to evaluate individual risk factors for the primary outcome of any invasive fungal infections and invasive candidiasis or invasive aspergillosis (when possible) within 1 y posttransplant. RESULTS We found 3 variables with a high certainty of evidence and strong associations (relative effect estimate ≥ 2) to any early invasive fungal infections across all solid organ transplant groups: reoperation (odds ratio [OR], 2.92; confidence interval [CI], 1.79-4.75), posttransplant renal replacement therapy (OR, 2.91; CI, 1.87-4.51), and cytomegalovirus disease (OR, 2.97; CI, 1.78-4.94). Both posttransplant renal replacement therapy (OR, 3.36; CI, 1.78-6.34) and posttransplant cytomegalovirus disease (OR, 2.81; CI, 1.47-5.36) increased the odds of early posttransplant invasive aspergillosis. No individual variables could be pooled across groups for invasive candidiasis. CONCLUSIONS Several common risk factors exist for the development of any invasive fungal infections in solid organ transplant recipients. Additional risk factors for invasive candidiasis and aspergillosis may be unique to the pathogen, transplanted organ, or both.
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Affiliation(s)
- Kelly M Pennington
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Max J Martin
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - M Hassan Murad
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - David Sanborn
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Steve G Peters
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Raymund R Razonable
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN
| | - Cassie C Kennedy
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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2
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Zachary J, Chen JM, Sharfuddin A, Yaqub M, Lutz A, Powelson J, Fridell JA, Barros N. Epidemiology and Risk Factors for Invasive Fungal Infections in Pancreas Transplant in the Absence of Postoperative Antifungal Prophylaxis. Open Forum Infect Dis 2023; 10:ofad478. [PMID: 37942464 PMCID: PMC10629350 DOI: 10.1093/ofid/ofad478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/20/2023] [Indexed: 11/10/2023] Open
Abstract
Background Invasive fungal infections (IFIs) remain a rare yet dreaded complication following pancreas transplantation. Current guidelines recommend antifungal prophylaxis in patients with 1 or more risk factors. At our center, single-dose antifungal prophylaxis is administered in the operating room but none subsequently, regardless of risk factors. Here we evaluate the 1-year incidence, outcome, and risk factors associated with IFI following pancreas transplantation. Methods A retrospective, single-center cohort study was conducted in patients who underwent pancreas transplantation between 1 January 2009 and 31 December 2019. Records were manually reviewed, and cases were adjudicated using consensus definitions. The 1-year cumulative incidence, mortality, and risk factors were analyzed by Kaplan-Meier method and differences between populations were assessed with Fisher test and Mann-Whitney U test. Results Three hundred sixty-nine recipients were included. Twelve IFIs were identified: candidiasis (8), aspergillosis (2), histoplasmosis (1), and cryptococcosis (1). Intra-abdominal infections were the most common presentation (5), followed by bloodstream infections (3), disseminated disease (2), pulmonary disease (1), and invasive fungal sinusitis (1). Median time to IFI was 64 days (interquartile range, 30-234 days). One-year cumulative incidence was 3.25% (95% confidence interval, 1.86%-5.65%). There were no significant differences between patients with or without IFI regarding type of transplant (P = .17), posttransplant dialysis (P = .3), rejection (P = .5), cytomegalovirus serostatus (P = .45), or reoperation (P = .19). For patients with IFI, the 1-year graft and patient survival rates were 58% versus 95% (P < .0001) and 75% versus 98.6% (P < .001), respectively. Conclusions Our study suggests that the use of a single-dose antifungal prophylaxis administered in the operating room but none subsequently does not result in an increased incidence of IFI following pancreas transplantation.
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Affiliation(s)
- Jessica Zachary
- Department of Pharmacy, Indiana University Health, Indianapolis, Indiana, USA
| | - Jeanne M Chen
- Department of Pharmacy, Indiana University Health, Indianapolis, Indiana, USA
| | - Asif Sharfuddin
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Muhammad Yaqub
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrew Lutz
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John Powelson
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jonathan A Fridell
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nicolas Barros
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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3
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Tarhini H, Waked R, Rahi M, Haddad N, Dorent R, Randoux C, Bunel V, Lariven S, Deconinck L, Rioux C, Yazdanpanah Y, Joly V, Ghosn J. Investigating infectious outcomes in adult patients undergoing solid organ transplantation: A retrospective single-center experience, Paris, France. PLoS One 2023; 18:e0291860. [PMID: 37797039 PMCID: PMC10553823 DOI: 10.1371/journal.pone.0291860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/07/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVES This study described the demographic characteristics, clinical presentation, treatment, and outcomes of solid organ transplant recipients who were admitted to our center for infection. It also determined factors associated with a poor outcome, and compares early and late period infections. METHODS In this retrospective observational study, conducted at a tertiary care center in France between October 2017 and March 2019, infectious outcomes of patients with solid organ transplant where studied. RESULTS A total of 104 patients were included with 158 hospitalizations for infection. Among these 104 patients, 71 (68%) were men. The median age was 59 years old. The most common symptoms on admission were fever (66%) and chills (31%). Lower respiratory tract infections were the most common diagnosis (71/158 hospitalizations). Urinary tract infections were frequently seen in kidney transplant recipients (25/60 hospitalizations). One or more infectious agents were isolated for 113 hospitalizations (72%): 70 bacteria, 36 viruses and 10 fungi, with predominance of gram-negative bacilli (53 cases) of which 13 were multidrug-resistant. The most frequently used antibiotics were third generation cephalosporins (40 cases), followed by piperacillin-tazobactam (26 cases). We note that 25 infections (16%) occurred during the first 6 months (early post-transplant period). Patients admitted during the early post-transplant period were more often on immunosuppressive treatment with prednisone (25/25 VS 106/133) (p = 0.01), mycophenolic acid (22/25 VS 86/133) (p = 0.03), presented for an urinary tract infection (10/25 VS 25/133) (p = 0.04) or a bacterial infection (17/25 VS 53/133) (p = 0.01). Patients with later infection had more comorbidities (57/83 VS 9/21) (p = 0.03), cancer (19/83 VS 0/21) (p = 0.04) or were on treatment with everolimus (46/133 VS 0/25) (p = 0.001). During 31 hospitalizations (20%), patients presented with a serious infection requiring intensive care (n = 26; 16%) or leading to death (n = 7; 4%). Bacteremia, pulmonary and cardiac complications were the main risk factors associated with poor outcome. CONCLUSION Infections pose a significant challenge in the care of solid organ transplant patients, particularly those with comorbidities and intensive immunosuppression. This underscores the crucial importance of continuous surveillance and epidemiologic monitoring within this patient population.
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Affiliation(s)
- Hassan Tarhini
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Rami Waked
- Division of Infectious Diseases, Maine Medical Center, Portland, ME, United States of America
| | - Mayda Rahi
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Nihel Haddad
- Service d’Hygiène Hospitalière, Pole Santé Publique, CHU Grenoble, La Tronche, France
| | - Richard Dorent
- Service de Chirurgie Cardiaque, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Christine Randoux
- Service de Néphrologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Vincent Bunel
- Service de Pneumologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Sylvie Lariven
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Laurene Deconinck
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Christophe Rioux
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Yazdan Yazdanpanah
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
- Université Paris Cité, Infection Modélisation Antimicrobial Evolution (IAME), Inserm UMR1137, Paris, France
| | - Veronique Joly
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Jade Ghosn
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
- Université Paris Cité, Infection Modélisation Antimicrobial Evolution (IAME), Inserm UMR1137, Paris, France
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4
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Chen S, Yu G, Chen M, You Y, Gu L, Wang Q, Wang H, Lai G, Yu Z, Wen W. Comparison of different therapeutic approaches for pulmonary cryptococcosis in kidney transplant recipients: a 15-year retrospective analysis. Front Med (Lausanne) 2023; 10:1107330. [PMID: 37484845 PMCID: PMC10361058 DOI: 10.3389/fmed.2023.1107330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/15/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Organ transplant recipients are at increased risk of developing pulmonary cryptococcosis (PC) due to weakened cell-mediated immunity caused by immunosuppressors. However, the nonspecific symptoms associated with PC can often lead to misdiagnosis and inappropriate treatment. Methods We conducted a retrospective analysis of data from 23 kidney transplant recipients with PC between April 2006 to January 2021. Results The median time from transplantation to the diagnosis of pathology-proven PC 4.09 years. Seventeen patients presented respiratory symptoms, including sputum-producing cough and dyspnea. Additionally, three patients also developed central nervous system (CNS) infections. Chest CT scans frequently revealed nodule-shaped lesions, which can mimic lung carcinoma. Serological tests did not demonstrate any specific changes. Nine patients received surgical resection as treatment. Fourteen patients were treated with antifungal medication only. No recurrence was observed in all 23 patients. Conclusion Our study suggests that fever and sputum-producing cough are common symptoms of PC, and cryptococcal meningitis should not be excluded if corresponding symptoms occur. Fluconazole is a common and effective antifungal agent. Surgical resection should be considered for patients who do not respond well to antifungal therapy. Clinicians should be aware of these findings when evaluating transplant recipients with respiratory symptoms.
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Affiliation(s)
- Shuyang Chen
- Department of Respiratory and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, Fuzhou, China
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guoqing Yu
- Department of Nephrology, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, Fuzhou, China
| | - Meiyan Chen
- Department of Respiratory and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, Fuzhou, China
| | - Yanjing You
- Department of Respiratory and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, Fuzhou, China
| | - Lei Gu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Wang
- The Third Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Huijuan Wang
- Department of Respiratory and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, Fuzhou, China
| | - Guoxiang Lai
- Department of Respiratory and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, Fuzhou, China
| | - Zongyang Yu
- Department of Respiratory and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, Fuzhou, China
| | - Wen Wen
- Department of Respiratory and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, Fuzhou, China
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5
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Zhang H, Wang K, Chen H, Sun L, Wang Z, Fei S, Tan R, Gu M. The Double-Edged Sword of Immunosuppressive Therapy in Kidney Transplantation: A Rare Case Report of Pulmonary Mucormycosis Post-Transplant and Literature Review. Front Med (Lausanne) 2020; 7:500. [PMID: 33072770 PMCID: PMC7538690 DOI: 10.3389/fmed.2020.00500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022] Open
Abstract
Immunosuppressive therapy is improving the graft survival of kidney transplant recipients and increasing the potential risk of infection. Pulmonary mucormycosis is a rare post-operative infection complication characterized with rapid deterioration and high mortality. In this case, a 33-year-old patient underwent a kidney transplantation with regular immunosuppressive therapy. Soon, 38 days post-transplant, pulmonary patchy shadows can be seen in the radiological examination and rounded into a large cavity formation with splenic rupture 25 days later. The diagnosis of mucormycosis was confirmed by lung biopsy and spleen histopathology. This case is a reminder that early diagnosis is imperative, meanwhile, rational antifungal therapy, timely elimination of immunosuppressants, and alternatively, abandoning the graft should be prudently assessed in the treatment of mucormycosis.
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Affiliation(s)
- Hengcheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Transplantation Research Center, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ke Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Chen
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li Sun
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zijie Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shuang Fei
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ruoyun Tan
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Gu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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6
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Garcia-Vidal C, Carratalà J, Lortholary O. Defining standards of CARE for invasive fungal diseases in solid organ transplant patients. J Antimicrob Chemother 2020; 74:ii16-ii20. [PMID: 31222312 DOI: 10.1093/jac/dkz039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Fungal infection in solid organ transplant (SOT) recipients is a challenge for physicians. Our aim was to review progress made within the past decade in managing the most important invasive fungal diseases in SOT recipients. Standards of care for candidosis, aspergillosis, mucormycosis and cryptococcosis in this special population are summarized.
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Affiliation(s)
- Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clínic de Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Jordi Carratalà
- Infectious Diseases Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Olivier Lortholary
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Molecular Mycology Unit, CNRS UMR, Paris, France.,Paris Descartes University, Necker Pasteur Center for Infectious Diseases and Tropical Medicine, IHU Imagine, APHP, Necker Enfants Malades University Hospital, Paris, France
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7
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Invasive Fungal Diseases in Kidney Transplant Recipients: Risk Factors for Mortality. J Clin Med 2020; 9:jcm9061824. [PMID: 32545280 PMCID: PMC7357124 DOI: 10.3390/jcm9061824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 01/13/2023] Open
Abstract
Background: Invasive fungal disease (IFD) is common in solid organ transplant (SOT) recipients and contributes to high morbidity and mortality. Although kidney transplantation (KT) is a commonly performed SOT, data on the risk factors for IFD-related mortality are limited. Methods: A 1:2 retrospective case-control study was performed in an experienced single center in the Republic of Korea. We reviewed the electronic medical records of patients with IFD after KT between February 1995 and March 2015. Results: Of 1963 kidney transplant recipients, 48 (2.5%) were diagnosed with IFD. The median interval from KT to IFD diagnosis was 172 days. Invasive aspergillosis (IA) was the most common, followed by invasive candidiasis (IC). Diabetes mellitus (DM) (odds ratio (OR) 3.72, 95% confidence interval (CI) 1.34–10.31, p = 0.011) and acute rejection (OR 3.41, 95% CI 1.41–8.21, p = 0.006) were associated with IFD development. In the subgroup analyses, concomitant bacterial infection was associated with IC development (OR 20.10, 95% CI 3.60–112.08, p = 0.001), and delayed graft function was associated with IA occurrence (OR 10.60, 95% CI 1.05–106.84, p = 0.045). The 12-week mortality rate in all patients was 50.0%. Mortality rates were significantly higher in older patients (adjusted hazard ratio (aHR) 1.06, 95% CI 1.02–1.11, p = 0.004), or those with DM (aHR 2.61, 95% CI 1.02–6.68, p = 0.044), deceased donor transplantation (aHR 2.68, 95% CI 1.03–6.95, p = 0.043), lymphocyte-depleting antibody usage (aHR 0.26, 95% CI 0.08–0.80, p = 0.019), acute rejection (aHR 0.38, 95% CI 0.15–0.97, p = 0.044), and concomitant bacterial infection (aHR 8.76, 95% CI 1.62–47.51, p = 0.012). Conclusions: A total of 50% of IFD cases occurred six months or later after transplantation. The IFD-related mortality rate was high in kidney transplant recipients despite the low incidence. DM and acute rejection were associated with high mortality, as well as IFD development. As old age, deceased donor transplantation, lymphocyte-depleting antibody usage, and concomitant bacterial infection are risk factors for IFD-related mortality, efforts for its early diagnosis and appropriate treatment are required.
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8
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Seok H, Huh K, Cho SY, Kang CI, Chung DR, Huh WS, Park JB, Peck KR. Risk factors for development and mortality of invasive pulmonary Aspergillosis in kidney transplantation recipients. Eur J Clin Microbiol Infect Dis 2020; 39:1543-1550. [PMID: 32279121 DOI: 10.1007/s10096-020-03871-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/18/2020] [Indexed: 01/22/2023]
Abstract
Invasive pulmonary aspergillosis (IPA) is a high mortality opportunistic infection among kidney transplant recipients. This study assessed the risk factors and outcomes of IPA after KT. A retrospective study was conducted at a tertiary-care referral hospital in Korea. Electronic medical records of patients diagnosed with IPA after KT between February 1995 and March 2015 were reviewed. The control patients comprised two patients who received KT before and after each IPA case. Twenty-six cases were diagnosed with IPA among 1963 recipients at a median of 58 years old. The most common cause of end-stage renal disease was diabetic nephropathy. The median time to diagnosis was 161 days. Delayed graft function was associated with the development of IPA. The overall 12-week mortality rate of IPA was 57.5%. Serum GM level ≥ 2 and BAL GM level ≥ 5 were associated with 12-week mortality in the Kaplan-Meier survival analyses. Approximately half of IPA in KT recipients developed during the late posttransplant period (> 6 months), especially after treatment for acute rejection. Careful monitoring for IPA is required in patients with delayed graft function, DM, and who received rejection therapy. Higher serum and BAL GM were associated with 12-week mortality.
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Affiliation(s)
- Hyeri Seok
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, Republic of Korea.,Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Korea University Medicine, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Kyungmin Huh
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, Republic of Korea
| | - Sun Young Cho
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, Republic of Korea
| | - Cheol-In Kang
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, Republic of Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, Republic of Korea
| | - Woo Seong Huh
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, Republic of Korea.
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9
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Gotur DB, Masud FN, Ezeana CF, Nisar T, Paranilam J, Chen S, Puppala M, Wong STC, Zimmerman JL. Sepsis outcomes in solid organ transplant recipients. Transpl Infect Dis 2019; 22:e13214. [PMID: 31755202 DOI: 10.1111/tid.13214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/27/2019] [Accepted: 11/10/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND We present data on a cohort of patients diagnosed with sepsis over a 10-year period comparing outcomes in solid organ transplant (SOT) and non-solid organ transplant (non-SOT) recipients. METHODS This is a retrospective single-center study of patients with diagnosis of sepsis from 1/1/06 to 6/30/16. Cases and controls were matched by year of sepsis diagnosis with propensity score matching. Conditional logistic regression and repeated measurement models were performed for binary outcomes. Trends over time for in-hospital mortality were determined using the Cochran-Armitage test. A gamma-distributed model was performed on the continuous variables. RESULTS Overall, there were 18 632 admission encounters with a discharge diagnosis of sepsis in 14 780 unique patients. Of those admissions, 1689 were SOT recipients. After 1:1 matching by year, there were three thousand three hundred and forty patients (1670 cases; 1670 controls) diagnosed with sepsis. There was a decreasing trend for in-hospital mortality for sepsis over time in SOT patients and non-SOT patients (P < .05) due to early sepsis recognition and improved standard of care. Despite higher comorbidities in the SOT group, conditional logistic regression showed that in-hospital mortality for sepsis in SOT patients was similar compared with non-SOT patients (odds ratio [OR] =1.14 [95% confidence interval {CI}, 0.95-1.37], P = .161). However, heart and lung SOT subgroups had higher odds of dying compared with the non-SOT group (OR = 1.83 [95% CI, 1.30-2.57], P < .001 and OR = 1.77 [95% CI, 1.34-2.34], P < .001). On average, SOT patients had 2 days longer hospital length of stay compared with non-SOT admissions (17.00 ± 19.54 vs 15.23 ± 17.07, P < .05). Additionally, SOT patients had higher odds of hospital readmission within 30 days (OR = 1.25 [95% CI, 1.06-1.51], P = .020), and higher odds for DIC compared with non-SOT patients (OR = 1.76 [95% CI, 1.10-2.86], P = .021). CONCLUSION Sepsis in solid organ transplants and non-solid organ transplant patients have similar mortality; however, the subset of heart and lung transplant recipients with sepsis has a higher rate of mortality compared with the non-solid organ transplant recipients. SOT with sepsis as a group has a higher hospital readmission rate compared with non-transplant sepsis patients.
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Affiliation(s)
- Deepa B Gotur
- Weill Cornell Medicine, Houston Methodist Hospital, Houstan, TX, USA
| | | | - Chika F Ezeana
- Informatics Development, Houston Methodist Hospital, Houstan, TX, USA
| | - Tariq Nisar
- Center for Outcomes Research, Houston Methodist Research Institute, Houstan, TX, USA
| | | | - Shenyi Chen
- Informatics Development, Houston Methodist Hospital, Houstan, TX, USA
| | - Mamta Puppala
- Informatics Development, Houston Methodist Hospital, Houstan, TX, USA
| | - Stephen T C Wong
- Institute for Academic Medicine, Houston Methodist Research Institute, Houstan, TX, USA.,Bioinformatics and Biostatistics Cores, Houston Methodist Cancer Center, Houstan, TX, USA.,Weill Cornell Medicine, Houstan, TX, USA
| | - Janice L Zimmerman
- Department of Medicine, Weill Cornell Medicine, Interim Head of Pulmonary, Critical care and Sleep Medicine, Houston Methodist Hospital, Houstan, TX, USA
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10
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Farges C, Cointault O, Murris M, Lavayssiere L, Lakhdar‐Ghazal S, Del Bello A, Hebral A, Esposito L, Nogier M, Sallusto F, Iriart X, Charpentier E, Guitard J, Muscari F, Dambrin C, Porte L, Kamar N, Cassaing S, Faguer S. Outcomes of solid organ transplant recipients with invasive aspergillosis and other mold infections. Transpl Infect Dis 2019; 22:e13200. [DOI: 10.1111/tid.13200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/09/2019] [Accepted: 09/29/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Cédric Farges
- Service de Parasitologie ‐ Mycologie Institut Fédératif de biologie Hôpital Purpan Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Olivier Cointault
- Département de Néphrologie et Transplantation d’organes Hôpital Rangueil Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Marlène Murris
- Service de Pneumologie Hôpital Larrey Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Laurence Lavayssiere
- Département de Néphrologie et Transplantation d’organes Hôpital Rangueil Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Shérazade Lakhdar‐Ghazal
- Service de Parasitologie ‐ Mycologie Institut Fédératif de biologie Hôpital Purpan Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Arnaud Del Bello
- Département de Néphrologie et Transplantation d’organes Hôpital Rangueil Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Anne‐Laure Hebral
- Département de Néphrologie et Transplantation d’organes Hôpital Rangueil Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Laure Esposito
- Département de Néphrologie et Transplantation d’organes Hôpital Rangueil Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Marie‐Béatrice Nogier
- Département de Néphrologie et Transplantation d’organes Hôpital Rangueil Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Federico Sallusto
- Service d’Urologie Hôpital Rangueil Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Xavier Iriart
- Service de Parasitologie ‐ Mycologie Institut Fédératif de biologie Hôpital Purpan Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Elena Charpentier
- Service de Parasitologie ‐ Mycologie Institut Fédératif de biologie Hôpital Purpan Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Joelle Guitard
- Département de Néphrologie et Transplantation d’organes Hôpital Rangueil Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Fabrice Muscari
- Service de Chirurgie Digestive Hôpital Rangueil Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Camille Dambrin
- Service de Chirurgie Cardio‐Vasculaire Hôpital Rangueil Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Lydie Porte
- Service des Maladies Infectieuses et Tropicales Hôpital Purpan Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Nassim Kamar
- Département de Néphrologie et Transplantation d’organes Hôpital Rangueil Centre Hospitalier Universitaire de Toulouse Toulouse France
- IFR–BMT Institut National de la Santé et de la Recherche Médicale U1043 Université Paul Sabatier Toulouse France
| | - Sophie Cassaing
- Service de Parasitologie ‐ Mycologie Institut Fédératif de biologie Hôpital Purpan Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d’organes Hôpital Rangueil Centre Hospitalier Universitaire de Toulouse Toulouse France
- Institut National de la Santé et de la Recherche Médicale UMR 1048 Institut des Maladies Métaboliques et Cardiovasculaires Université Paul Sabatier Toulouse France
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11
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Bodro M, Ferrer J, Ricart MJ, Sanclemente G, Linares L, Cervera C, Cofan F, Ventura-Aguiar P, Lopez-Boado MÁ, Marco F, Fuster J, García-Valdecasas JC, Moreno A. Epidemiology, risk factors, and impact of bacterial infections on outcomes for pancreatic grafts. Clin Transplant 2018; 32:e13333. [PMID: 29920780 DOI: 10.1111/ctr.13333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2018] [Indexed: 12/25/2022]
Abstract
We aimed to determine the epidemiology, risk factors, and impact of bacterial infection on pancreatic function after pancreas transplantation. Data for pancreas transplant recipients were retrospectively reviewed between 2000 and 2014 for at least 1 year. We collected and analyzed post-transplant data for bacterial infection, morbidity, and mortality. During the study period, 312 pancreas transplants were performed. In total, 509 episodes of bacterial infection were diagnosed in 191 patients (61%). Multidrug-resistant (MDR) organisms were present in 173 of the 513 isolated microorganisms (33%). Risk factors independently associated with bacterial infection were acute allograft rejection (OR 1.7, 95%CI 1.1-3), the need for post-transplant hemodialysis, (OR 5.3, 95%CI 1.8-15.7) and surgical re-intervention (OR 2.8, 95%CI 1.5-5.1), which was also considered a risk factor for infections caused by MDR bacteria. Graft survival was associated with the occurrence of one or more episodes of bacterial infection (log-rank test = 0.009). Surgical re-intervention was independently associated with graft loss (OR 2.5, 95%CI 1.3-4.7). To conclude, pancreas recipients frequently experienced bacterial infections associated with the need for hemodialysis or surgical re-intervention. Infection by MDR organisms is a growing concern in these patients and was related to graft survival. Graft loss was independently associated with surgical re-intervention.
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Affiliation(s)
- Marta Bodro
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Joana Ferrer
- Hepatobiliopancreatic Surgery Department and Transplant Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - María José Ricart
- Kidney Transplant Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Gemma Sanclemente
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Laura Linares
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carlos Cervera
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Frederic Cofan
- Kidney Transplant Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pedro Ventura-Aguiar
- Kidney Transplant Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Miguel Ángel Lopez-Boado
- Hepatobiliopancreatic Surgery Department and Transplant Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Francesc Marco
- Microbiology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Josep Fuster
- Hepatobiliopancreatic Surgery Department and Transplant Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Juan Carlos García-Valdecasas
- Hepatobiliopancreatic Surgery Department and Transplant Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
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12
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Echenique IA, Angarone MP, Gordon RA, Rich J, Anderson AS, McGee EC, Abicht TO, Kang J, Stosor V. Invasive fungal infection after heart transplantation: A 7-year, single-center experience. Transpl Infect Dis 2017; 19. [DOI: 10.1111/tid.12650] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 07/19/2016] [Accepted: 09/12/2016] [Indexed: 01/05/2023]
Affiliation(s)
- Ignacio A. Echenique
- Division of Infectious Diseases; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Michael P. Angarone
- Division of Infectious Diseases; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Robert A. Gordon
- Division of Cardiology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Jonathan Rich
- Division of Cardiology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Allen S. Anderson
- Division of Cardiology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Edwin C. McGee
- Division of Cardiac Surgery; Department of Surgery; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Travis O. Abicht
- Division of Cardiac Surgery; Department of Surgery; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Joseph Kang
- Division of Biostatistics; Department of Preventative Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Valentina Stosor
- Division of Infectious Diseases; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
- Division of Organ Transplantation; Department of Surgery; Northwestern University Feinberg School of Medicine; Chicago IL USA
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13
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Enoch DA, Yang H, Aliyu SH, Micallef C. The Changing Epidemiology of Invasive Fungal Infections. Methods Mol Biol 2017; 1508:17-65. [PMID: 27837497 DOI: 10.1007/978-1-4939-6515-1_2] [Citation(s) in RCA: 228] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
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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Affiliation(s)
- David A Enoch
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK.
| | - Huina Yang
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
| | - Sani H Aliyu
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
| | - Christianne Micallef
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
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14
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López-Medrano F, Fernández-Ruiz M, Silva JT, Carver PL, van Delden C, Merino E, Pérez-Saez MJ, Montero M, Coussement J, de Abreu Mazzolin M, Cervera C, Santos L, Sabé N, Scemla A, Cordero E, Cruzado-Vega L, Martín-Moreno PL, Len Ó, Rudas E, de León AP, Arriola M, Lauzurica R, David M, González-Rico C, Henríquez-Palop F, Fortún J, Nucci M, Manuel O, Paño-Pardo JR, Montejo M, Muñoz P, Sánchez-Sobrino B, Mazuecos A, Pascual J, Horcajada JP, Lecompte T, Moreno A, Carratalà J, Blanes M, Hernández D, Fariñas MC, Andrés A, Aguado JM. Clinical Presentation and Determinants of Mortality of Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: A Multinational Cohort Study. Am J Transplant 2016; 16:3220-3234. [PMID: 27105907 DOI: 10.1111/ajt.13837] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/24/2016] [Accepted: 04/17/2016] [Indexed: 01/25/2023]
Abstract
The prognostic factors and optimal therapy for invasive pulmonary aspergillosis (IPA) after kidney transplantation (KT) remain poorly studied. We included in this multinational retrospective study 112 recipients diagnosed with probable (75.0% of cases) or proven (25.0%) IPA between 2000 and 2013. The median interval from transplantation to diagnosis was 230 days. Cough, fever, and expectoration were the most common symptoms at presentation. Bilateral pulmonary involvement was observed in 63.6% of cases. Positivity rates for the galactomannan assay in serum and bronchoalveolar lavage samples were 61.3% and 57.1%, respectively. Aspergillus fumigatus was the most commonly identified species. Six- and 12-week survival rates were 68.8% and 60.7%, respectively, and 22.1% of survivors experienced graft loss. Occurrence of IPA within the first 6 months (hazard ratio [HR]: 2.29; p-value = 0.027) and bilateral involvement at diagnosis (HR: 3.00; p-value = 0.017) were independent predictors for 6-week all-cause mortality, whereas the initial use of a voriconazole-based regimen showed a protective effect (HR: 0.34; p-value = 0.007). The administration of antifungal combination therapy had no apparent impact on outcome. In conclusion, IPA entails a dismal prognosis among KT recipients. Maintaining a low clinical suspicion threshold is key to achieve a prompt diagnosis and to initiate voriconazole therapy.
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Affiliation(s)
- F López-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain.
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J T Silva
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - P L Carver
- University of Michigan Health System, Ann Harbor, MI
| | - C van Delden
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - E Merino
- Unit of Infectious Diseases, Hospital Universitario General, Alicante, Spain
| | - M J Pérez-Saez
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - M Montero
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J Coussement
- Department of Nephrology, Dialysis and Kidney Transplantation, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M de Abreu Mazzolin
- Division of Nephology, Department of Medicine, Universidade Federal de São Paulo-UNIFESP and Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - C Cervera
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - L Santos
- Unit of Renal Transplantation, Department of Urology and Kidney Transplantation, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - N Sabé
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - A Scemla
- Service de Néphrologie et Transplantation Adulte, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Paris, France
| | - E Cordero
- Unit of Infectious Diseases, Hospitales Universitarios "Vigen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - L Cruzado-Vega
- Department of Nephrology, Hospital Universitario "La Fe", Valencia, Spain
| | - P L Martín-Moreno
- Department of Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Ó Len
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - E Rudas
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - A P de León
- Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, México
| | - M Arriola
- Clínica de Nefrología, Urología y Enfermedades Cardiovasculares, Santa Fe, Argentina
| | - R Lauzurica
- Department of Nephrology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M David
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C González-Rico
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - F Henríquez-Palop
- Department of Nephrology, University Hospital "Doctor Negrín", Las Palmas de Gran Canaria, Spain
| | - J Fortún
- Department of Infectious Diseases, University Hospital "Ramón y Cajal", Madrid, Spain
| | - M Nucci
- Department of Internal Medicine, Hematology Service and Mycology Laboratory, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - O Manuel
- Department of Infectious Diseases and Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - J R Paño-Pardo
- Department of Internal Medicine, Hospital Universitario "La Paz", School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Montejo
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Bilbao, Spain
| | - P Muñoz
- Department of Microbiology and Infectious Diseases, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - B Sánchez-Sobrino
- Department of Nephrology, Hospital Universitario Puerta de Hierro-Majadahonda, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - A Mazuecos
- Department of Nephrology, Hospital Universitario "Puerta del Mar", Cádiz, Spain
| | - J Pascual
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J P Horcajada
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - T Lecompte
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - A Moreno
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - M Blanes
- Unit of Infectious Diseases, Hospital Universitario "La Fe", Valencia, Spain
| | - D Hernández
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - M C Fariñas
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - A Andrés
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
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15
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Giannella M, Bartoletti M, Morelli M, Cristini F, Tedeschi S, Campoli C, Tumietto F, Bertuzzo V, Ercolani G, Faenza S, Pinna AD, Lewis RE, Viale P. Antifungal prophylaxis in liver transplant recipients: one size does not fit all. Transpl Infect Dis 2016; 18:538-44. [PMID: 27237076 DOI: 10.1111/tid.12560] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/21/2016] [Accepted: 03/19/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Targeted antifungal prophylaxis against Candida species or against Candida species and Aspergillus species, according to individual patient risk factors (RFs), is recommended by experts. However, recent studies have reported fluconazole is as effective as broader spectrum antifungals for preventing invasive fungal infection (IFI) after liver transplantation (LT). METHODS We performed a retrospective cohort study of all adult patients who underwent LT at our 1420-bed tertiary teaching hospital, from June 2010 to December 2014, to assess the rate and etiology of IFI within 100 days after LT, to investigate the compliance with targeted prophylaxis, and to analyze risk factors for developing IFI. RESULTS In total, 303 patients underwent LT. Patients were classified as having low (no RFs), intermediate (1 RF for invasive candidiasis [IC]), and high risk (1 RF for invasive aspergillosis [IA] or ≥2 RFs for IC) for IFI in 20%, 30%, and 50% of cases, respectively. A total of 139 patients received antifungal prophylaxis: 98 with a mold-active drug and 41 with fluconazole. Overall adherence to targeted prophylaxis was 53%. Nineteen patients (6.3%) developed IFI: 7 IC and 12 IA. Multivariate Cox regression analysis, adjusted for median model for end-stage liver disease score at LT, stratification risk group, and adherence to targeted prophylaxis, showed that graft dysfunction, renal replacement therapy, and prophylaxis with fluconazole were independent risk factors for IFI. Seven of the 9 patients who received fluconazole prophylaxis and developed IFI were classified as having high risk for IFI, and 6 developed IA. CONCLUSION Recommended stratification is accurate for predicting patients at very high risk for IFI, who should receive prophylaxis with a mold-active drug.
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Affiliation(s)
- M Giannella
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - M Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - M Morelli
- Liver and Multi-Organ Transplant Unit, Department of Medical and Surgical Sciences, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - F Cristini
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - S Tedeschi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - C Campoli
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - F Tumietto
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - V Bertuzzo
- Liver and Multi-Organ Transplant Unit, Department of Medical and Surgical Sciences, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - G Ercolani
- Liver and Multi-Organ Transplant Unit, Department of Medical and Surgical Sciences, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - S Faenza
- Anesthesiology Unit, Department of Medical and Surgical Sciences, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - A D Pinna
- Liver and Multi-Organ Transplant Unit, Department of Medical and Surgical Sciences, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - R E Lewis
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - P Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
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16
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López-Medrano F, Silva JT, Fernández-Ruiz M, Carver PL, van Delden C, Merino E, Pérez-Saez MJ, Montero M, Coussement J, de Abreu Mazzolin M, Cervera C, Santos L, Sabé N, Scemla A, Cordero E, Cruzado-Vega L, Martín-Moreno PL, Len Ó, Rudas E, de León AP, Arriola M, Lauzurica R, David M, González-Rico C, Henríquez-Palop F, Fortún J, Nucci M, Manuel O, Paño-Pardo JR, Montejo M, Muñoz P, Sánchez-Sobrino B, Mazuecos A, Pascual J, Horcajada JP, Lecompte T, Lumbreras C, Moreno A, Carratalà J, Blanes M, Hernández D, Hernández-Méndez EA, Fariñas MC, Perelló-Carrascosa M, Morales JM, Andrés A, Aguado JM. Risk Factors Associated With Early Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: Results From a Multinational Matched Case-Control Study. Am J Transplant 2016; 16:2148-57. [PMID: 26813515 DOI: 10.1111/ajt.13735] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/13/2016] [Indexed: 01/25/2023]
Abstract
Risk factors for invasive pulmonary aspergillosis (IPA) after kidney transplantation have been poorly explored. We performed a multinational case-control study that included 51 kidney transplant (KT) recipients diagnosed with early (first 180 posttransplant days) IPA at 19 institutions between 2000 and 2013. Control recipients were matched (1:1 ratio) by center and date of transplantation. Overall mortality among cases was 60.8%, and 25.0% of living recipients experienced graft loss. Pretransplant diagnosis of chronic pulmonary obstructive disease (COPD; odds ratio [OR]: 9.96; 95% confidence interval [CI]: 1.09-90.58; p = 0.041) and delayed graft function (OR: 3.40; 95% CI: 1.08-10.73; p = 0.037) were identified as independent risk factors for IPA among those variables already available in the immediate peritransplant period. The development of bloodstream infection (OR: 18.76; 95% CI: 1.04-339.37; p = 0.047) and acute graft rejection (OR: 40.73, 95% CI: 3.63-456.98; p = 0.003) within the 3 mo prior to the diagnosis of IPA acted as risk factors during the subsequent period. In conclusion, pretransplant COPD, impaired graft function and the occurrence of serious posttransplant infections may be useful to identify KT recipients at the highest risk of early IPA. Future studies should explore the potential benefit of antimold prophylaxis in this group.
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Affiliation(s)
- F López-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J T Silva
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - P L Carver
- University of Michigan Health System, Ann Arbor, MI
| | - C van Delden
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - E Merino
- Unit of Infectious Diseases, Hospital Universitario General, Alicante, Spain
| | - M J Pérez-Saez
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - M Montero
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J Coussement
- Department of Nephrology, Dialysis and Kidney Transplantation, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M de Abreu Mazzolin
- Division of Nephology, Department of Medicine, Universidade Federal de São Paulo-UNIFESP and Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - C Cervera
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - L Santos
- Unit of Renal Transplantation, Department of Urology and Kidney Transplantation, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - N Sabé
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - A Scemla
- Service de Néphrologie et Transplantation Adulte, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Paris, France
| | - E Cordero
- Unit of Infectious Diseases, Hospitales Universitarios "Vigen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - L Cruzado-Vega
- Department of Nephrology, Hospital Universitario "La Fe", Valencia, Spain
| | - P L Martín-Moreno
- Department of Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Ó Len
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - E Rudas
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - A Ponce de León
- Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, México
| | - M Arriola
- Clínica de Nefrología, Urología y Enfermedades Cardiovasculares, Santa Fe, Argentina
| | - R Lauzurica
- Department of Nephrology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M David
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C González-Rico
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - F Henríquez-Palop
- Department of Nephrology, University Hospital "Doctor Negrín", Las Palmas de Gran Canaria, Spain
| | - J Fortún
- Department of Infectious Diseases, University Hospital "Ramón y Cajal", Madrid, Spain
| | - M Nucci
- Department of Internal Medicine, Hematology Service and Mycology Laboratory, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - O Manuel
- Department of Infectious Diseases and Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - J R Paño-Pardo
- Department of Internal Medicine, Hospital Universitario "La Paz", School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Montejo
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Bilbao, Spain
| | - P Muñoz
- Department of Microbiology and Infectious Diseases, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - B Sánchez-Sobrino
- Department of Nephrology, Hospital Universitario Puerta de Hierro-Majadahonda, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - A Mazuecos
- Department of Nephrology, Hospital Universitario "Puerta del Mar", Cádiz, Spain
| | - J Pascual
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J P Horcajada
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - T Lecompte
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - C Lumbreras
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Moreno
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - M Blanes
- Unit of Infectious Diseases, Hospital Universitario "La Fe", Valencia, Spain
| | - D Hernández
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - E A Hernández-Méndez
- Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, México
| | - M C Fariñas
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - M Perelló-Carrascosa
- Department of Nephrology, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - J M Morales
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Andrés
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
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Robinson C, Chau C, Yerkovich S, Azzopardi M, Hopkins P, Chambers D. Posaconazole in lung transplant recipients: use, tolerability, and efficacy. Transpl Infect Dis 2016; 18:302-8. [DOI: 10.1111/tid.12497] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/04/2015] [Accepted: 11/01/2015] [Indexed: 11/29/2022]
Affiliation(s)
- C.L. Robinson
- Toowoomba Base Hospital; Toowoomba Queensland Australia
| | - C. Chau
- School of Pharmacy; The University of Queensland; Brisbane Queensland Australia
| | - S.T. Yerkovich
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
- Queensland Lung Transplant Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - M. Azzopardi
- Queensland Lung Transplant Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - P. Hopkins
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
- Queensland Lung Transplant Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - D. Chambers
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
- Queensland Lung Transplant Service; The Prince Charles Hospital; Brisbane Queensland Australia
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18
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Xin H. Active immunizations with peptide-DC vaccines and passive transfer with antibodies protect neutropenic mice against disseminated candidiasis. Vaccine 2015; 34:245-251. [PMID: 26620842 DOI: 10.1016/j.vaccine.2015.11.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 10/28/2015] [Accepted: 11/13/2015] [Indexed: 12/13/2022]
Abstract
We previously report that peptide-pulsed dendritic cell (DC) vaccination, which targeting two peptides (Fba and Met6) expressed on the cell surface of Candida albicans, can induce high degree of protection against disseminated candidiasis in immunocompetent mice. Passive transfer of immune sera from the peptide immunized mice or peptide-related monoclonal antibodies demonstrated that protection was medicated by peptide-specific antibodies. In this study the efficacy of active and passive immunization against disseminated candidiasis was tested in mice with cyclophosphamide-induced neutropenia. Peptide-DC vaccines were given to mice prior to induction of neutropenia. We show active immunization with either Fba or Met6 peptide-DC vaccine significantly improved the survival and reduced the fungal burden of disseminated candidiasis in those immunocompromised mice. Importantly, we show that administration of two protective monoclonal antibodies also protect neutropenic mice against the disease, implying possibility of developing a successful passive immunotherapy strategy to treat the disease and protect against disseminated candidiasis. The results of this study are crucial as they address the fundamental questions as to whether the synthetic peptide vaccine induced immunity protects the host during a neutropenic episode. We anticipate that this peptide-vaccine study will serve as the foundation of future investigations into new peptide vaccines comprised of cell surface peptides from other medically important Candida species, as well as other fungi.
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Affiliation(s)
- Hong Xin
- Department of Pediatrics, Louisiana State University Health Sciences Center and Research Institute for Children, Children's Hospital, New Orleans, LA 70118, United States.
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19
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Raman N, Lee MR, Lynn DM, Palecek SP. Antifungal Activity of 14-Helical β-Peptides against Planktonic Cells and Biofilms of Candida Species. Pharmaceuticals (Basel) 2015; 8:483-503. [PMID: 26287212 PMCID: PMC4588179 DOI: 10.3390/ph8030483] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 07/29/2015] [Accepted: 08/04/2015] [Indexed: 12/16/2022] Open
Abstract
Candida albicans is the most prevalent cause of fungal infections and treatment is further complicated by the formation of drug resistant biofilms, often on the surfaces of implanted medical devices. In recent years, the incidence of fungal infections by other pathogenic Candida species such as C. glabrata, C. parapsilosis and C. tropicalis has increased. Amphiphilic, helical β-peptide structural mimetics of natural antimicrobial α-peptides have been shown to exhibit specific planktonic antifungal and anti-biofilm formation activity against C. albicans in vitro. Here, we demonstrate that β-peptides are also active against clinically isolated and drug resistant strains of C. albicans and against other opportunistic Candida spp. Different Candida species were susceptible to β-peptides to varying degrees, with C. tropicalis being the most and C. glabrata being the least susceptible. β-peptide hydrophobicity directly correlated with antifungal activity against all the Candida clinical strains and species tested. While β-peptides were largely ineffective at disrupting existing Candida biofilms, hydrophobic β-peptides were able to prevent the formation of C. albicans, C. glabrata, C. parapsilosis and C. tropicalis biofilms. The broad-spectrum antifungal activity of β-peptides against planktonic cells and in preventing biofilm formation suggests the promise of this class of molecules as therapeutics.
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Affiliation(s)
- Namrata Raman
- Department of Chemical and Biological Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI 53706, USA.
| | - Myung-Ryul Lee
- Department of Chemical and Biological Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI 53706, USA.
| | - David M Lynn
- Department of Chemical and Biological Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI 53706, USA.
- Department of Chemistry, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI 53706, USA.
| | - Sean P Palecek
- Department of Chemical and Biological Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI 53706, USA.
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20
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Trubiano JA, Chen S, Slavin MA. An Approach to a Pulmonary Infiltrate in Solid Organ Transplant Recipients. CURRENT FUNGAL INFECTION REPORTS 2015; 9:144-154. [PMID: 32218881 PMCID: PMC7091299 DOI: 10.1007/s12281-015-0229-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The onset of a pulmonary infiltrate in a solid organ transplant (SOT) recipient is both a challenging diagnostic and therapeutic challenge. We outline the potential aetiologies of a pulmonary infiltrate in a SOT recipient, with particular attention paid to fungal pathogens. A diagnostic and empirical therapy approach to a pulmonary infiltrate, especially invasive fungal disease (IFD) in SOT recipients, is provided.
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Affiliation(s)
- Jason A. Trubiano
- Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, VIC Australia
- Infectious Diseases, Austin Health, Melbourne, VIC Australia
- Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne, VIC 3002 Australia
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead Hospital, Sydney, Australia
| | - Monica A. Slavin
- Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, VIC Australia
- Infectious Diseases, Royal Melbourne Hospital, Melbourne, VIC Australia
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21
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Miano M, Scalzone M, Perri K, Palmisani E, Caviglia I, Micalizzi C, Svahn J, Calvillo M, Banov L, Terranova P, Lanza T, Dufour C, Fioredda F. Mycophenolate mofetil and Sirolimus as second or further line treatment in children with chronic refractory Primitive or Secondary Autoimmune Cytopenias: a single centre experience. Br J Haematol 2015; 171:247-253. [PMID: 26058843 DOI: 10.1111/bjh.13533] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/30/2015] [Indexed: 01/19/2023]
Abstract
The management of refractory autoimmune cytopenias in childhood is challenging due to the lack of established evidence on escalating treatments. The long-term efficacy of immunosuppressive drugs was evaluated in children with refractory autoimmune cytopenias referred to the Haematology Unit of the Gaslini Children's Hospital between 2001 and 2014. Patients were grouped into three categories: autoimmune lymphoproliferative syndrome (ALPS), ALPS-related syndrome (at least one absolute/primary additional criterion for ALPS) and primary autoimmune cytopenia (PAC, cytopenia with no other immunological symptoms/signs). Fifty-eight children (aged 1-16 years) entered the study: 12 were categorized with ALPS, 24 were ALPS-related and 22 had PAC. Five didn't receive treatment. Fifty-three were initially treated with steroids/intravenous immunoglobulin. Fourteen responded, whereas 39 did not. Of these 39 patients, 34 (87%) received mycophenolate mofetil (MMF) as second/further-line treatment and 22 (65%) responded. Within these 34 subjects, ALPS patients responded better (11/11, 100%) than the two other groups pooled together (11/23, 48%; P = 0·002). Sirolimus was given as second/further-line treatment to 16 children, and 12 (75%) responded, including 8 who previously failed MMF therapy. Median follow-up was 3·46 years. MMF and Sirolimus were well-tolerated and enabled partial/complete and sustained remission in most children. These drugs may be successfully and safely used in children with refractory autoimmune cytopenias with or without ALPS/ALPS-related disorders and may represent a valid second/further line option.
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Affiliation(s)
- Maurizio Miano
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Maria Scalzone
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Katia Perri
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Elena Palmisani
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Ilaria Caviglia
- Infectious Disease Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Concetta Micalizzi
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Johanna Svahn
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Michaela Calvillo
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Laura Banov
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Paola Terranova
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Tiziana Lanza
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Carlo Dufour
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Francesca Fioredda
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
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22
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Maraki S, Hamilos G, Dimopoulou D, Andrianaki AM, Karageorgiadis AS, Kyvernitakis A, Lionakis S, Kofteridis DP, Samonis G. Study on the comparative activity of echinocandins on murine gut colonization byCandida albicans. Med Mycol 2015; 53:597-602. [DOI: 10.1093/mmy/myv028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/28/2015] [Indexed: 12/18/2022] Open
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23
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Bodro M, Sanclemente G, Lipperheide I, Allali M, Marco F, Bosch J, Cofan F, Ricart MJ, Esforzado N, Oppenheimer F, Moreno A, Cervera C. Impact of antibiotic resistance on the development of recurrent and relapsing symptomatic urinary tract infection in kidney recipients. Am J Transplant 2015; 15:1021-7. [PMID: 25676738 DOI: 10.1111/ajt.13075] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 01/25/2023]
Abstract
We sought to determine the frequency, risk factors, and clinical impact of recurrent urinary tract infections (UTI) in kidney transplant recipients. Of 867 patients who received a kidney transplant between 2003 and 2010, 174 (20%) presented at least one episode of UTI. Fifty-five patients presented a recurrent UTI (32%) and 78% of them could be also considered relapsing episodes. Recurrent UTI was caused by extended-spectrum betalactamase (ESBL)-producing Klebsiella pneumoniae (31%), followed by non-ESBL producing Escherichia coli (15%), multidrug-resistant (MDR) Pseudomonas aeruginosa (14%), and ESBL-producing E. coli (13%). The variables associated with a higher risk of recurrent UTI were a first or second episode of infection by MDR bacteria (OR 12; 95%CI 528), age >60 years (OR 2.2; 95%CI 1.15.1), and reoperation (OR 3; 95%CI 1.37.1). In addition, more relapses were recorded in patients with UTI caused by MDR organisms than in those with susceptible microorganisms. There were no differences in acute rejection, graft function, graft loss or 1 year mortality between groups. In conclusion, recurrent UTI is frequent among kidney recipients and associated with MDR organism. Classic risk factors for UTI (female gender and diabetes) are absent in kidney recipients, thus highlighting the relevance of uropathogens in this population.
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Affiliation(s)
- M Bodro
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
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24
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Liss B, Vehreschild JJ, Bangard C, Maintz D, Frank K, Grönke S, Michels G, Hamprecht A, Wisplinghoff H, Markiefka B, Hekmat K, Vehreschild MJGT, Cornely OA. Our 2015 approach to invasive pulmonary aspergillosis. Mycoses 2015; 58:375-82. [DOI: 10.1111/myc.12319] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 03/09/2015] [Accepted: 03/09/2015] [Indexed: 12/13/2022]
Affiliation(s)
- B. Liss
- Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
- Center for Integrated Oncology CIO KölnBonn; University of Cologne; Cologne Germany
| | - J. J. Vehreschild
- Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
- Center for Integrated Oncology CIO KölnBonn; University of Cologne; Cologne Germany
- German Centre for Infection Research (DZIF); partner site Bonn-Cologne; Cologne Germany
| | - C. Bangard
- Department of Radiology; University Hospital of Cologne; Cologne Germany
| | - D. Maintz
- Department of Radiology; University Hospital of Cologne; Cologne Germany
| | - K. Frank
- Department III of Internal Medicine; Heart Centre of the University of Cologne; Cologne Germany
| | - S. Grönke
- Department III of Internal Medicine; Heart Centre of the University of Cologne; Cologne Germany
| | - G. Michels
- Department III of Internal Medicine; Heart Centre of the University of Cologne; Cologne Germany
| | - A. Hamprecht
- Institute for Medical Microbiology; Immunology and Hygiene; University Hospital of Cologne; Cologne Germany
| | - H. Wisplinghoff
- Institute for Medical Microbiology; Immunology and Hygiene; University Hospital of Cologne; Cologne Germany
| | - B. Markiefka
- Institute of Pathology; University Hospital of Cologne; Cologne Germany
| | - K. Hekmat
- Department of Cardiothoracic Surgery; University Hospital of Cologne; Cologne Germany
| | - M. J. G. T. Vehreschild
- Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
- Center for Integrated Oncology CIO KölnBonn; University of Cologne; Cologne Germany
- German Centre for Infection Research (DZIF); partner site Bonn-Cologne; Cologne Germany
| | - O. A. Cornely
- Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
- Center for Integrated Oncology CIO KölnBonn; University of Cologne; Cologne Germany
- German Centre for Infection Research (DZIF); partner site Bonn-Cologne; Cologne Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD); University of Cologne; Cologne Germany
- Clinical Trials Centre Cologne; ZKS Köln; University of Cologne; Cologne Germany
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25
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Molecular Diagnosis in Fungal Infection Control. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2015. [DOI: 10.1007/s40506-015-0040-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Lecefel C, Eloy P, Chauvin B, Wyplosz B, Amilien V, Massias L, Taburet AM, Francois H, Furlan V. Worsening pneumonitis due to a pharmacokinetic drug-drug interaction between everolimus and voriconazole in a renal transplant patient. J Clin Pharm Ther 2014; 40:119-20. [DOI: 10.1111/jcpt.12234] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 10/26/2014] [Indexed: 01/22/2023]
Affiliation(s)
- C. Lecefel
- Clinical Pharmacy; Bicetre Hospital; AP/HP; Le Kremlin Bicetre France
| | - P. Eloy
- Clinical Pharmacy; Bicetre Hospital; AP/HP; Le Kremlin Bicetre France
| | - B. Chauvin
- Clinical Pharmacy; Bicetre Hospital; AP/HP; Le Kremlin Bicetre France
| | - B. Wyplosz
- Infectious Disease Clinical Unit; Bicetre Hospital; AP/HP; Le Kremlin Bicetre France
| | - V. Amilien
- Intensive Care Unit; Bicetre Hospital; AP/HP; Le Kremlin Bicetre France
| | - L. Massias
- Clinical Pharmacy; Bichat Claude Bernard Hospital; AP/HP; Paris
| | - A.-M. Taburet
- Clinical Pharmacy; Bicetre Hospital; AP/HP; Le Kremlin Bicetre France
| | - H. Francois
- Nephrology Department; Bicetre Hospital; AP/HP; Le Kremlin Bicetre France
| | - V. Furlan
- Clinical Pharmacy; Bicetre Hospital; AP/HP; Le Kremlin Bicetre France
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27
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Bekaoui S, Haddiya I, El Housni S, ElHarraqui R, Rhou H, Benamar L, Eziatouni F, Ouzeddoun N, Bayahia R. [Spinal tuberculosis in renal transplant complicated by systemic fungal infection]. Pan Afr Med J 2014; 19:22. [PMID: 25667684 PMCID: PMC4314135 DOI: 10.11604/pamj.2014.19.22.2878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 08/13/2014] [Indexed: 11/20/2022] Open
Abstract
En transplantation, les complications infectieuses sont fréquentes et de diagnostic souvent délicat. Elles peuvent coexister chez le transplanté rénal rendant leur diagnostic encore plus difficile. Le but de ce cas clinique est de discuter les difficultés diagnostiques et de surveillance de deux types de pathologies assez fréquentes chez le transplanté rénal, qui sont la tuberculose et la mycose, à travers l’observation clinique d’une patiente de 24 ans transplantée rénale qui présente une spondylodiscite tuberculeuse et qui développe secondairement une septicémie à Candida non albicans à point de départ urinaire dont le seul point d’appel est la fièvre post opératoire.
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Affiliation(s)
- Samira Bekaoui
- Service de néphrologie-dialyse-transplantation rénale, CHU Ibn Sina, Rabat, Maroc
| | - Intissar Haddiya
- Service de néphrologie-dialyse-transplantation rénale, CHU Ibn Sina, Rabat, Maroc
| | - Siham El Housni
- Service de néphrologie-dialyse-transplantation rénale, CHU Ibn Sina, Rabat, Maroc
| | - Ryme ElHarraqui
- Service de néphrologie-dialyse-transplantation rénale, CHU Ibn Sina, Rabat, Maroc
| | - Hakima Rhou
- Service de néphrologie-dialyse-transplantation rénale, CHU Ibn Sina, Rabat, Maroc
| | - Loubna Benamar
- Service de néphrologie-dialyse-transplantation rénale, CHU Ibn Sina, Rabat, Maroc
| | - Fatima Eziatouni
- Service de néphrologie-dialyse-transplantation rénale, CHU Ibn Sina, Rabat, Maroc
| | - Naima Ouzeddoun
- Service de néphrologie-dialyse-transplantation rénale, CHU Ibn Sina, Rabat, Maroc
| | - Rabia Bayahia
- Service de néphrologie-dialyse-transplantation rénale, CHU Ibn Sina, Rabat, Maroc
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Gavaldà J, Meije Y, Fortún J, Roilides E, Saliba F, Lortholary O, Muñoz P, Grossi P, Cuenca-Estrella M. Invasive fungal infections in solid organ transplant recipients. Clin Microbiol Infect 2014; 20 Suppl 7:27-48. [DOI: 10.1111/1469-0691.12660] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Nieves DJ, Arrieta AC. Recent Studies on Invasive Fungal Diseases in Children and Adolescents: an Update. CURRENT FUNGAL INFECTION REPORTS 2014. [DOI: 10.1007/s12281-013-0172-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Crabol Y, Lortholary O. Invasive mold infections in solid organ transplant recipients. SCIENTIFICA 2014; 2014:821969. [PMID: 25525551 PMCID: PMC4261198 DOI: 10.1155/2014/821969] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/03/2014] [Indexed: 05/13/2023]
Abstract
Invasive mold infections represent an increasing source of morbidity and mortality in solid organ transplant recipients. Whereas there is a large literature regarding invasive molds infections in hematopoietic stem cell transplants, data in solid organ transplants are scarcer. In this comprehensive review, we focused on invasive mold infection in the specific population of solid organ transplant. We highlighted epidemiology and specific risk factors for these infections and we assessed the main clinical and imaging findings by fungi and by type of solid organ transplant. Finally, we attempted to summarize the diagnostic strategy for detection of these fungi and tried to give an overview of the current prophylaxis treatments and outcomes of these infections in solid organ transplant recipients.
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Affiliation(s)
- Yoann Crabol
- Université Paris Descartes, Sorbonne Paris Cité, Centre d'Infectiologie Necker Pasteur, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, APHP, 75015 Paris, France
| | - Olivier Lortholary
- Université Paris Descartes, Sorbonne Paris Cité, Centre d'Infectiologie Necker Pasteur, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, APHP, 75015 Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, CNRS URA3012, 75015 Paris, France
- *Olivier Lortholary:
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Risk factors and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in solid-organ transplant recipients. Transplantation 2013; 96:843-9. [PMID: 23883973 DOI: 10.1097/tp.0b013e3182a049fd] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although infections due to the six ESKAPE pathogens have recently been identified as a serious emerging problem, information regarding bacteremia caused by these organisms in solid-organ transplant (SOT) recipients is lacking. We sought to determine the frequency, risk factors, and outcomes of bacteremia due to drug-resistant ESKAPE (rESKAPE) organisms in liver, kidney, and heart adult transplant recipients. METHODS All episodes of bacteremia prospectively documented in hospitalized SOT recipients from 2007 to 2012 were analyzed. RESULTS Of 276 episodes of bacteremia, 54 (19.6%) were due to rESKAPE strains (vancomycin-resistant Enterococcus faecium [0], methicillin-resistant Staphylococcus aureus [5], extended-spectrum β-lactamase-producing Klebsiella pneumoniae [10], carbapenem-resistant Acinetobacter baumannii [8], carbapenem- and quinolone-resistant Pseudomonas aeruginosa [26], and derepressed chromosomal β-lactam and extended-spectrum β-lactamase-producing Enterobacter species [5]). Factors independently associated with rESKAPE bacteremia were prior transplantation, septic shock, and prior antibiotic therapy. Patients with rESKAPE bacteremia more often received inappropriate empirical antibiotic therapy than the others (41% vs. 21.6%; P=0.01). Overall case-fatality rate (30 days) was higher in patients with rESKAPE bacteremia (35.2% vs. 14.4%; P=0.001). CONCLUSIONS Bacteremia due to rESKAPE pathogens is frequent in SOT recipients and causes significant morbidity and mortality. rESKAPE organisms should be considered when selecting empirical antibiotic therapy for hospitalized SOT recipients presenting with septic shock, particularly those with prior transplantation and antibiotic use.
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Trabelsi H, Néji S, Sellami H, Yaich S, Cheikhrouhou F, Guidara R, Charffedine K, Makni F, Hachicha J, Ayadi A. Invasive fungal infections in renal transplant recipients: About 11 cases. J Mycol Med 2013; 23:255-60. [DOI: 10.1016/j.mycmed.2013.07.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 07/06/2013] [Accepted: 07/06/2013] [Indexed: 11/16/2022]
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Abstract
The diagnosis and management of children with autoimmune cytopenias can be challenging. Children can present with immune-mediated destruction of a single-cell lineage or multiple cell lineages, including platelets (immune thrombocytopenia [ITP]), erythrocytes (autoimmune hemolytic anemia), and neutrophils (autoimmune neutropenia). Immune-mediated destruction can be primary or secondary to a comorbid immunodeficiency, malignancy, rheumatologic condition, or lymphoproliferative disorder. Treatment options generally consist of nonspecific immune suppression or modulation. This nonspecific approach is changing as recent insights into disease biology have led to targeted therapies, including the use of thrombopoietin mimetics in ITP and sirolimus for cytopenias associated with autoimmune lymphoproliferative syndrome.
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