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. 2020 Jan 1;70(1):30-39.
doi: 10.1093/cid/ciz156.

Invasive Fungal Infection After Lung Transplantation: Epidemiology in the Setting of Antifungal Prophylaxis

Arthur W Baker  1   2 , Eileen K Maziarz  1 , Christopher J Arnold  3 , Melissa D Johnson  1   2 , Adrienne D Workman  1 , John M Reynolds  4 , John R Perfect  1 , Barbara D Alexander  1   5
Affiliations

Invasive Fungal Infection After Lung Transplantation: Epidemiology in the Setting of Antifungal Prophylaxis

Arthur W Baker et al. Clin Infect Dis. .

Abstract

Background: Lung transplant recipients commonly develop invasive fungal infections (IFIs), but the most effective strategies to prevent IFIs following lung transplantation are not known.

Methods: We prospectively collected clinical data on all patients who underwent lung transplantation at a tertiary care academic hospital from January 2007-October 2014. Standard antifungal prophylaxis consisted of aerosolized amphotericin B lipid complex during the transplant hospitalization. For the first 180 days after transplant, we analyzed prevalence rates and timing of IFIs, risk factors for IFIs, and data from IFIs that broke through prophylaxis.

Results: In total, 156 of 815 lung transplant recipients developed IFIs (prevalence rate, 19.1 IFIs per 100 surgeries, 95% confidence interval [CI] 16.4-21.8%). The prevalence rate of invasive candidiasis (IC) was 11.4% (95% CI 9.2-13.6%), and the rate of non-Candida IFIs was 8.8% (95% CI 6.9-10.8%). First episodes of IC occurred a median of 31 days (interquartile range [IQR] 16-56 days) after transplant, while non-Candida IFIs occurred later, at a median of 86 days (IQR 40-121 days) after transplant. Of 169 IFI episodes, 121 (72%) occurred in the absence of recent antifungal prophylaxis; however, IC and non-Candida breakthrough IFIs were observed, most often representing failures of micafungin (n = 16) and aerosolized amphotericin B (n = 24) prophylaxis, respectively.

Conclusions: Lung transplant recipients at our hospital had high rates of IFIs, despite receiving prophylaxis with aerosolized amphotericin B lipid complex during the transplant hospitalization. These data suggest benefit in providing systemic antifungal prophylaxis targeting Candida for up to 90 days after transplant and extending mold-active prophylaxis for up to 180 days after surgery.

Keywords: invasive fungal infection; lung transplantation; prophylaxis.

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Figures

Figure 1.
Figure 1.
Prevalence rates of IFIs, stratified by Candida and non-Candida IFIs, among 815 lung transplant recipients who underwent lung transplantation from 2007 through 2014. Prevalence rates were calculated for the first 180 days after transplantation. For each time period, prevalence rates were compared to 2007–2009 prevalence rates. Prevalence rates, prevalence rate ratios, and 95% confidence intervals are given. Abbreviations: IFI, invasive fungal infection; PR, prevalence rate; PRR, prevalence rate ratio.
Figure 2.
Figure 2.
Cumulative incidence of IFIs, stratified by Candida and non-Candida IFIs, among 815 lung transplant recipients who underwent lung transplantation from 2007 through 2014. IFIs were limited to the first 180 days after transplantation. For each patient, only the first IFI for each category was considered. Abbreviation: IFI, invasive fungal infection.
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References

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