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Aguado JM, Ruiz-Camps I, Muñoz P, Mensa J, Almirante B, Vázquez L, Rovira M, Martín-Dávila P, Moreno A, Alvarez-Lerma F, León C, Madero L, Ruiz-Contreras J, Fortún J, Cuenca-Estrella M. [Guidelines for the treatment of Invasive Candidiasis and other yeasts. Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). 2010 Update]. Enferm Infecc Microbiol Clin 2011; 29:345-61. [PMID: 21459489 DOI: 10.1016/j.eimc.2011.01.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 01/17/2011] [Indexed: 12/29/2022]
Abstract
These guidelines are an update of the recommendations of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) that were issued in 2004 (Enferm Infecc Microbiol Clin. 2004, 22:32-9) on the treatment of Invasive Candidiasis and infections produced by other yeasts. This 2010 update includes a comprehensive review of the new drugs that have appeared in recent years, as well as the levels of evidence for recommending them. These guidelines have been developed following the rules of the SEIMC by a working group composed of specialists in infectious diseases, clinical microbiology, critical care medicine, paediatrics and oncology-haematology. It provides a series of general recommendations regarding the management of invasive candidiasis and other yeast infections, as well as specific guidelines for prophylaxis and treatment, which have been divided into four sections: oncology-haematology, solid organ transplantation recipients, critical patients, and paediatric patients.
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Affiliation(s)
- José María Aguado
- Servicio de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, España. Red Española de Investigación en Patología Infecciosa (REIPI RD06/0008)
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52
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Pozo Laderas JC. [Antifungal prophylaxis in HIV-seropositive liver transplant recipients]. Rev Iberoam Micol 2011; 28:183-90. [PMID: 21420504 DOI: 10.1016/j.riam.2011.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 03/01/2011] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Seropositive human immunodeficiency virus (HIV) patients have a high prevalence of chronic liver disease for which liver transplantation is the only possible treatment. Risk of fungal infection in this population may be very high. CASE REPORT We describe the clinical course of the early postoperative period in a patient coinfected with HIV and hepatitis C virus undergoing liver transplantation. We discuss antifungal prophylaxis indications and drugs of choice in relation to their efficacy and safety profile. Other medical treatments are described, as well as possible pharmacokinetic interactions. CONCLUSIONS Antifungal prophylaxis with anidulafungin has proven effective and has presented no significant adverse effects on a patient at high risk of fungal infection and multiple risk factors for drug interactions.
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53
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Sensoy G, Belet N. Invasive Candida infections in solid organ transplant recipient children. Expert Rev Anti Infect Ther 2011; 9:317-24. [PMID: 21417871 DOI: 10.1586/eri.11.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Solid organ transplantation (SOT) is now an accepted therapy for many end-stage organ disorders and fungal infections are the principal cause of infection-related mortality in SOT recipients. Among invasive fungal infections, Candida species are the most common pathogens identified, associated with high mortality rates. The epidemiology and clinical manifestations of Candida infections vary with the type of organ transplantation. This article reviews invasive Candida infections in pediatric SOT recipients.
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Affiliation(s)
- Gülnar Sensoy
- Department of Pediatric Infectious Diseases, Ondokuz Mayıs University Hospital, Kurupelit, Samsun, Turkey.
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54
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Abstract
Solid organ transplantation is emerging as a lifesaving procedure for increasing numbers of patients, and invasive fungal infections are a significant cause of mortality and morbidity for patients undergoing such procedures. Risks for developing these infections are continuing to evolve, leading to shifts in the epidemiology of invasive mycoses occurring after transplantation. Targeting preventive efforts to select solid organ transplantation groups at highest risk for invasive fungal infections is critical to optimizing prophylaxis strategies. The epidemiology of posttransplantation fungal infections, antifungal drug interactions and side effects, and new diagnostic capabilities should be considered when choosing an approach to antifungal prophylaxis for this population.
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55
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Affiliation(s)
- P G Pappas
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.
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56
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Grossi PA. Clinical Aspects of Invasive Candidiasis in Solid Organ Transplant Recipients. Drugs 2009; 69 Suppl 1:15-20. [DOI: 10.2165/11315510-000000000-00000] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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57
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Abstract
Although the overall incidence of fungal infections in liver transplant recipients has declined, these infections still contribute significantly to the morbidity and mortality of patients with risk factors for infection. Although antifungal prophylaxis has been widely studied and practiced, no consensus exists on which patients should receive prophylaxis, with which agent, and for what duration. Numerous studies have attempted to ascertain independent risk factors for invasive fungal infections in liver transplant patients, and these data, in addition to clinical trials, identify several patient groups at exceedingly high risk of fungal infection. These include retransplant patients, patients with renal failure requiring hemodialysis or renal replacement therapy, and those requiring reoperations after transplant. Because the majority of infections occur in the first month after transplantation, prophylaxis should be continued for 4-6 weeks. However, local epidemiology and research should guide decisions regarding choice of agent as well as overall development of interinstitutional guidelines, because the incidence and spectrum of infection may differ dramatically among institutions. Liver Transpl 15:842-858, 2009. (c) 2009 AASLD.
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58
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Prophylaxis With Caspofungin for Invasive Fungal Infections in High-Risk Liver Transplant Recipients. Transplantation 2009; 87:424-35. [DOI: 10.1097/tp.0b013e3181932e76] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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59
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Hadley S, Huckabee C, Pappas PG, Daly J, Rabkin J, Kauffman CA, Merion RM, Karchmer AW. Outcomes of antifungal prophylaxis in high-risk liver transplant recipients. Transpl Infect Dis 2008; 11:40-8. [PMID: 19144094 DOI: 10.1111/j.1399-3062.2008.00361.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Antifungal prophylaxis for liver transplant recipients (LTRs) is common among patients considered at high risk of infection, but optimal prophylaxis duration and drug has not been defined. This study aimed to assess the effects of 14 days of antifungal therapy prophylaxis in reducing proven invasive fungal infections (IFI) in high-risk subjects. Eligible subjects who met 2 or more risk criteria were randomized 1:1 to the treatment arms (liposomal amphotericin B or fluconazole) and were followed for 100 days post transplantation for evidence of IFI. The study was designed to enroll 300 subjects, but was closed early for insufficient enrollment. A total of 71 subjects were enrolled and randomized. Two-thirds of subjects completed 14 days of study therapy. Ten subjects developed proven or probable IFI with Candida species (9 subjects) and Cryptococcus neoformans (1 subject); rates were similar in the 2 treatment arms. Eleven subjects died, but no death was attributed to study drug or IFI. In summary, high-risk LTRs tolerated antifungal prophylaxis well, and rates of IFI were lower than previously reported in untreated high-risk LTRs.
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Affiliation(s)
- S Hadley
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA.
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60
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Abstract
The 21st century has brought forth vast innovations in the healthcare field. The availability and use of aggressive chemotherapeutic and immunosuppressive agents as well as broad-spectrum antibacterial agents has created a large population of patients who are at increased risk of acquiring infections with fungal organisms, especially Candida species. This review will focus on the changing epidemiology of candidal bloodstream infections, its impact on healthcare and new advances in the diagnosis and treatment of candidemia.
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Affiliation(s)
- Amy Chang
- Division of Infectious Diseases, Thomas Jefferson University, Suite 210, 211 South 9th Street, Philadelphia, PA 19107, USA
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61
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Seton M, Pless M, Fishman JA, Caruso PA, Hedley-Whyte ET. Case records of the Massachusetts General Hospital. Case 18-2008. A 68-year-old man with headache and visual changes after liver transplantation. N Engl J Med 2008; 358:2619-28. [PMID: 18550878 DOI: 10.1056/nejmcpc0802849] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Margaret Seton
- Rheumatology, Allergy, and Immunology Division and Rheumatology Unit, Massachusetts General Hospital, USA
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62
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Danziger-Isakov LA, Worley S, Arrigain S, Aurora P, Ballmann M, Boyer D, Conrad C, Eichler I, Elidemir O, Goldfarb S, Mallory GB, Michaels MG, Michelson P, Mogayzel PJ, Parakininkas D, Solomon M, Visner G, Sweet S, Faro A. Increased mortality after pulmonary fungal infection within the first year after pediatric lung transplantation. J Heart Lung Transplant 2008; 27:655-61. [PMID: 18503966 DOI: 10.1016/j.healun.2008.03.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 02/20/2008] [Accepted: 03/12/2008] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Risk factors, morbidity and mortality from pulmonary fungal infections (PFIs) within the first year after pediatric lung transplant have not previously been characterized. METHODS A retrospective, multicenter study from 1988 to 2005 was conducted with institutional approval from the 12 participating centers in North America and Europe. Data were recorded for the first post-transplant year. The log-rank test assessed for the association between PFI and survival. Associations between time to PFI and risk factors were assessed by Cox proportional hazards models. RESULTS Of the 555 subjects transplanted, 58 (10.5%) had 62 proven (Candida, Aspergillus or other) or probable (Aspergillus or other) PFIs within the first year post-transplant. The mean age for PFI subjects was 14.0 years vs 11.4 years for non-PFI subjects (p < 0.01). Candida and Aspergillus species were recovered equally for proven disease. Comparing subjects with PFI (n = 58) vs those without (n = 404), pre-transplant colonization was associated with PFI (hazard ratio [HR] 2.0; 95% CI 0.95 to 4.3, p = 0.067). Cytomegalovirus (CMV) mismatch, tacrolimus-based regimen and age >15 years were associated with PFI (p < 0.05). PFI was associated with any prior rejection higher than Grade A2 (HR 2.1; 95% CI 1.2 to 3.6). Cystic fibrosis, induction therapy, transplant era and type of transplant were not associated with PFI. PFI was independently associated with decreased 12-month survival (HR 3.9, 95% CI 2.2 to 6.8). CONCLUSIONS Risk factors for PFI include Grade A2 rejection, repeated acute rejection, CMV-positive donor, tacrolimus-based regimen and pre-transplant colonization.
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Affiliation(s)
- Lara A Danziger-Isakov
- Department of Pediatric Infectious Diseases, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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63
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Spectrum and risk factors for invasive candidiasis and non-Candida fungal infections after liver transplantation. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200804010-00010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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64
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Affiliation(s)
- Jay A Fishman
- Transplant Infectious Disease and Compromised Host Program, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114, USA.
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65
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Fungal infections in solid organ transplantation. Curr Opin Organ Transplant 2007. [DOI: 10.1097/mot.0b013e3282f1fc12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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66
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Teisseyre J, Kaliciński P, Markiewicz-Kijewska M, Szymczak M, Ismail H, Drewniak T, Nachulewicz P, Broniszczak D, Teisseyre M, Pawłowska J, Garczewska B. Aspergillosis in children after liver transplantation: Single center experience. Pediatr Transplant 2007; 11:868-75. [PMID: 17976121 DOI: 10.1111/j.1399-3046.2007.00754.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Aspergillus infection in immunocompromised patients is associated with high morbidity and mortality. We retrospectively reviewed cases of Aspergillosis (A), in a series of 277 children who received LTx between 1990 and 2006. All children were given antifungal prophylaxis after transplantation. Aspergillosis was identified in 10 cases (3.6%) and diagnosis was confirmed when clinical symptoms were associated with identification of Aspergillus sp. or detection of galactomannan antigen. Incidence of Aspergillosis considerably decreased from 6.9% to 0.6% when liposomal amphotericin B was introduced as prophylaxis in high-risk patients. Mean time since LTx to Aspergillosis was 14.5 days. Histologically, Aspergillosis was diagnosed in two cases. Galactomannan antigen was present in two recipients. Aspergillus infection occurs usually within first 30 days after transplantation as a result of a combination of several risk factors. Following risk factors were observed: multiple antibiotic therapy, prolonged intensive care unit stay, poor graft function, retransplantation, relaparotomies, co-infection. Amphotericin B was administered in all cases. Two patients (20%) died because of Aspergillosis Liposomal Amphotericin B prophylaxis in high-risk children decreases the incidence of Aspergillus infection. High index of suspicion and early diagnosis followed by intensive treatment with amphotericin B facilitates achieving mortality rate lower than presented in other reports.
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Affiliation(s)
- Joanna Teisseyre
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland.
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67
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Bougnoux ME, Kac G, Aegerter P, d'Enfert C, Fagon JY. Candidemia and candiduria in critically ill patients admitted to intensive care units in France: incidence, molecular diversity, management and outcome. Intensive Care Med 2007; 34:292-9. [PMID: 17909746 DOI: 10.1007/s00134-007-0865-y] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Accepted: 09/02/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the concomitant incidence, molecular diversity, management and outcome of nosocomial candidemia and candiduria in intensive care unit (ICU) patients in France. DESIGN A 1-year prospective observational study in 24 adult ICUs. PATIENTS Two hundred and sixty-two patients with nosocomial candidemia and/or candiduria. MEASUREMENTS AND RESULTS Blood and urine samples were collected when signs of sepsis were present. Antifungal susceptibility of Candida strains was determined; in addition, all blood and 72% of urine C. albicans isolates were analyzed by using multi-locus sequence type (MLST). The mean incidences of candidemia and candiduria were 6.7 and 27.4/1000 admissions, respectively. Eight percent of candiduric patients developed candidemia with the same species. The mean interval between ICU admission and candidemia was 19.0 +/- 2.9 days, and 17.2 +/- 1.1 days for candiduria. C. albicans and C. glabrata were isolated in 54.2% and 17% of blood and 66.5% and 21.6% of urine Candida-positive cultures, respectively. Fluconazole was the most frequently prescribed agent. In all candidemic patients, the prescribed curative antifungal agent was active in vitro against the responsible identified strain. Crude ICU mortality was 61.8% for candidemic and 31.3% for candiduric patients. Seventy-five percent of the patients were infected with a unique C. albicans strain; cross-transmission between seven patients was suggested in one hospital. CONCLUSIONS Candidemia is late-onset ICU-acquired infection associated with high mortality. No difference in susceptibility and genetic background were found between blood and urine strains of Candida species.
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Affiliation(s)
- Marie-Elisabeth Bougnoux
- Hôpital Necker-Enfants Malades, Service de Bactériologie, Virologie, Parasitologie et Hygiène, 149, rue de Sèvres, 75473 Paris Cedex 15, France.
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68
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Akamatsu N, Sugawara Y, Kaneko J, Tamura S, Makuuchi M. Preemptive Treatment of Fungal Infection Based on Plasma (1 → 3)β-D-Glucan Levels after Liver Transplantation. Infection 2007; 35:346-51. [PMID: 17885729 DOI: 10.1007/s15010-007-6240-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Accepted: 05/03/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Invasive fungal infection remains a major challenge in liver transplantation and the mortality rate is high. Early diagnosis and treatment are required for better results. PATIENTS We prospectively measured plasma (1 --> 3)beta-D-glucan (BDG) levels in 180 living donor liver transplant recipients for 1 year after surgery. Fungal infection was defined as proposed by the European Organization for Research and Treatment of Cancer/Mycoses Study Group. Preemptive treatment (intravenous fluconazole and trimethoprim-sulfamethoxazole) was started when the BDG level was greater than 40 pg/ml. RESULTS Twenty-four patients (13%) were diagnosed with invasive fungal infection. The responsible pathogens included Candida spp. in 14 cases, Aspergillus fumigatus in 5, Cryptococcus neoformans in 3, and Pneumocystis jiroveci in 2. Preemptive treatment was performed in 22% of patients (n = 40). Renal impairment and mild gastrointestinal intolerance due to the drugs were observed in 28% (11/40) of patients during treatment. Among them 14 patients were diagnosed with fungal infection including seven candidiasis, five aspergillosis, and two Pneumocystis jiroveci pneumonia. The sensitivity and specificity of BDG for overall fungal infection was 58% and 83%, respectively, with a positive predictive value of 35% and a negative predictive value of 93%, and a positive likelihood ratio of 3.41 and a negative likelihood ratio of 1.98. The overall mortality for fungal infection in our series was 0.6%. CONCLUSION Although the sensitivity and positive predictive value were low, the low mortality rate after fungal infection and the mild side effects of the preemptive treatment might justify our therapeutic strategy. Based on the effectiveness, this strategy warrants further investigation.
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Affiliation(s)
- N Akamatsu
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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69
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Gabardi S, Kubiak DW, Chandraker AK, Tullius SG. Invasive fungal infections and antifungal therapies in solid organ transplant recipients. Transpl Int 2007; 20:993-1015. [PMID: 17617181 DOI: 10.1111/j.1432-2277.2007.00511.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This manuscript will review the risk factors, prevalence, clinical presentation, and management of invasive fungal infections (IFIs) in solid organ transplant (SOT) recipients. Primary literature was obtained via MEDLINE (1966-April 2007) and EMBASE. Abstracts were obtained from scientific meetings or pharmaceutical manufacturers and included in the analysis. All studies and abstracts evaluating IFIs and/or antifungal therapies, with a primary focus on solid organ transplantation, were considered for inclusion. English-language literature was selected for inclusion, but was limited to those consisting of human subjects. Infectious complications following SOT are common. IFIs are associated with high morbidity and mortality rates in this patient population. Determining the best course of therapy is difficult due to the limited availability of data in SOT recipients. Well-designed clinical studies are infrequent and much of the available information is often based on case-reports or retrospective analyses. Transplant practitioners must remain aware of their therapeutic options and the advantages and disadvantages associated with the available treatment alternatives.
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Affiliation(s)
- Steven Gabardi
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, USA.
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Abstract
PURPOSE OF REVIEW New broader spectrum antifungal agents with favorable safety profiles have been available for the last 15 years making prophylaxis feasible. The purpose of this article is to review recent studies in patient populations at high risk for invasive fungal infections. RECENT FINDINGS Itraconazole, lipid formulations of amphotericin B, posaconazole, caspofungin and micafungin have been utilized for prophylaxis in different immunocompromised host settings. Itraconazole and caspofungin remain an option especially in patients with hematological diseases. Low dose liposomal amphotericin B shows a lower morbidity rate in patients treated for acute myeloid leukemia. Posaconazole demonstrated survival benefits in this setting although data have only been presented at an international meeting. In the transplantation setting, micafungin was superior to fluconazole during the early neutropenic phase and posaconazole was superior to fluconazole in preventing invasive aspergillosis in hematopoietic transplant recipients treated for graft-versus-host disease. Results from the latter study have thus far only been presented in abstract form. SUMMARY Prophylaxis should only be given to a high-risk population. Results of studies should demonstrate morbidity and mortality advantages. The new generation of azoles and echinocandins have a favorable safety and drug interaction profile and appear advantageous in specific settings of immunosuppression. Pending full publication, posaconazole appears to be an appropriate agent for prophylaxis in acute myeloid leukemia patients or patients treated for graft-versus-host disease. Micafungin is superior to fluconazole in the neutropenic phase of hematopoietic transplantation.
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Affiliation(s)
- Andrew J Ullmann
- Third Department of Internal Medicine, Klinikum der Johannes Gutenberg-Universität, Mainz, Germany.
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71
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Abstract
Fungal infections in solid organ transplant recipients continue to be a significant cause of morbidity and mortality. Candida spp. and Aspergillus spp. account for most invasive fungal infections. The incidence of fungal infection varies with type of solid organ transplant. Liver transplant recipients have highest reported incidence of candida infections while lung transplant recipients have highest rate of Aspergillus infections. Recent epidemiological studies suggest the emergence of resistant strains of candida as well as mycelial fungi other than Aspergillus in these patients. The current review incorporates the recent changes in the epidemiology of fungal infections in solid organ transplant recipients and highlights the newer data on the diagnosis, prophylaxis and treatment of fungal infections in these patients.
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Affiliation(s)
- Fernanda P Silveira
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
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72
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Magill SS, Dropulic LK. Antifungal prophylaxis in transplant recipients: where do we go from here? Transpl Infect Dis 2006; 8:187-9. [PMID: 17116131 DOI: 10.1111/j.1399-3062.2006.00181.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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