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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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Shekhova E, Salazar F, Da Silva Dantas A, Chakraborty T, Wooding EL, White PL, Warris A. Age difference of patients with and without invasive aspergillosis: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:220. [PMID: 38373908 PMCID: PMC10875810 DOI: 10.1186/s12879-024-09109-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/06/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Invasive Aspergillosis (IA) is a life-threatening fungal disease with significant mortality rates. Timely diagnosis and treatment greatly enhance patient outcomes. This study aimed to explore the association between patient age and the development of IA, as well as the potential implications for risk stratification strategies. METHODS We searched National Center for Biotechnology Information (NCBI) databases for publications until October 2023 containing age characteristics of patients with and without IA. A random-effects model with the application of inverse-variance weighting was used to pool reported estimates from each study, and meta-regression and subgroup analyses were utilized to assess sources of heterogeneity. RESULTS A systematic review was conducted, resulting in the inclusion of 55 retrospective observational studies with a total of 13,983 patients. Meta-analysis revealed that, on average, patients with IA were approximately two and a half years older (95% Confidence Interval [CI] 1.84-3.31 years; I2 = 26.1%) than those without the disease (p < 0.0001). No significant moderators could explain the observed heterogeneity in age difference. However, subgroup analysis revealed that age differences were more pronounced within particular patient groups compared to others. For example, patients with and without IA who had primary severe lung infections exhibited a greater difference in mean age than other patient cohorts. CONCLUSIONS Further research, such as individual patient data meta-analysis, is necessary to better understand the potential relationship between increasing age and the likelihood of IA. Improved risk stratification strategies based on patient age could potentially enhance the early detection and treatment of IA, ultimately improving patient outcomes.
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Affiliation(s)
- Elena Shekhova
- Medical Research Council Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK.
| | - Fabián Salazar
- Medical Research Council Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
| | | | - Tanmoy Chakraborty
- Medical Research Council Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
| | - Eva L Wooding
- Medical Research Council Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
- Royal Devon and Exeter Hospital, Exeter, EX2 5DW, UK
| | - P Lewis White
- Public Health Wales Microbiology Cardiff, Cardiff University, UHW, Cardiff, UK
- Centre for Trials Research, Division of Infection and Immunity, Cardiff University, UHW, Cardiff, UK
| | - Adilia Warris
- Medical Research Council Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
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Ramírez-Sánchez IC, Diaz-Sanabria RA, Alza-Arcila J. Invasive pulmonary aspergillosis following human metapneumovirus infection in solid-organ transplant recipients: Another virus to add to the list. Transpl Infect Dis 2024; 26:e14188. [PMID: 37938791 DOI: 10.1111/tid.14188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/22/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
There is increasing recognition that respiratory viral infections such as influenza, respiratory syncytial virus, parainfluenza virus, adenovirus, and SARS-CoV-2 can promote the development of invasive fungal pulmonary coinfections, particularly invasive aspergillosis, both in immunocompetent and immunocompromised patients. To date, there are no case reports exploring the role of human metapneumovirus as a risk factor for fungal coinfection. Below, we describe the case of a 63-year-old woman who received a kidney transplant and developed invasive pulmonary aspergillosis after a human metapneumovirus infection and discuss the possible phenomena that could favor this association.
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Affiliation(s)
- Isabel Cristina Ramírez-Sánchez
- Infectious Diseases Section, Internal Medicine Department, Hospital Pablo Tobón Uribe, Medical School, Medellín, Colombia
- Infectious Diseases Section, Internal Medicine Department, Universidad de Antioquia, Medical School, Medellín, Colombia
| | - Ricardo Augusto Diaz-Sanabria
- Infectious Diseases Section, Internal Medicine Department, Universidad de Antioquia, Medical School, Medellín, Colombia
| | - Jhongert Alza-Arcila
- Infectious Diseases Section, Internal Medicine Department, Universidad de Antioquia, Medical School, Medellín, Colombia
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Silva JT, Husain S, Aguado JM. Isavuconazole for Treating Invasive Mould Disease in Solid Organ Transplant Recipients. Transpl Int 2023; 36:11845. [PMID: 38161768 PMCID: PMC10754982 DOI: 10.3389/ti.2023.11845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024]
Abstract
Solid organ transplant (SOT) recipients have a higher risk of developing invasive mould diseases (IMD). Isavuconazole is a novel broad-spectrum azole active against Aspergillus spp. and Mucor, well tolerated, with an excellent bioavailability and predictable pharmacokinetics, that penetrates in most tissues rapidly, and has few serious adverse effects, including hepatic toxicity. Contrary to other broad-spectrum azoles, such as voriconazole and posaconazole, isavuconazole appears to show significant smaller drug-drug interactions with anticalcineurin drugs. We have performed an extensive literature review of the experience with the use of isavuconazole in SOT, which included the SOTIS and the ISASOT studies, and published case reports. More than 140 SOT recipients treated with isavuconazole for IMD were included. Most patients were lung and kidney recipients treated for an Aspergillus infection. Isavuconazole was well tolerated (less than 10% of patients required treatment discontinuation). The clinical responses appeared comparable to that found in other high-risk patient populations. Drug-drug interactions with immunosuppressive agents were manageable after the reduction of tacrolimus and the adjustment of mTOR inhibitors at the beginning of treatment. In conclusion, isavuconazole appears to be a reasonable option for the treatment of IMD in SOT. More clinical studies are warranted.
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Affiliation(s)
- Jose Tiago Silva
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación del Hospital 12 de Octubre (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Shahid Husain
- Department of Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - José María Aguado
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación del Hospital 12 de Octubre (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Tio SY, Chen SCA, Hamilton K, Heath CH, Pradhan A, Morris AJ, Korman TM, Morrissey O, Halliday CL, Kidd S, Spelman T, Brell N, McMullan B, Clark JE, Mitsakos K, Hardiman RP, Williams P, Campbell AJ, Beardsley J, Van Hal S, Yong MK, Worth LJ, Slavin MA. Invasive aspergillosis in adult patients in Australia and New Zealand: 2017-2020. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 40:100888. [PMID: 37701716 PMCID: PMC10494171 DOI: 10.1016/j.lanwpc.2023.100888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/25/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023]
Abstract
Background New and emerging risks for invasive aspergillosis (IA) bring the need for contemporary analyses of the epidemiology and outcomes of IA, in order to improve clinical practice. Methods The study was a retrospective, multicenter, cohort design of proven and probable IA in adults from 10 Australasian tertiary centres (January 2017-December 2020). Descriptive analyses were used to report patients' demographics, predisposing factors, mycological characteristics, diagnosis and management. Accelerated failure-time model was employed to determine factor(s) associated with 90-day all-cause mortality (ACM). Findings Of 382 IA episodes, 221 (in 221 patients) fulfilled inclusion criteria - 53 proven and 168 probable IA. Median patient age was 61 years (IQR 51-69). Patients with haematologic malignancies (HM) comprised 49.8% of cases. Fifteen patients (6.8%) had no pre-specified immunosuppression and eleven patients (5.0%) had no documented comorbidity. Only 30% of patients had neutropenia. Of 170 isolates identified, 40 (23.5%) were identified as non-Aspergillus fumigatus species complex. Azole-resistance was present in 3/46 (6.5%) of A. fumigatus sensu stricto isolates. Ninety-day ACM was 30.3%. HM (HR 1.90; 95% CI 1.04-3.46, p = 0.036) and ICU admission (HR 4.89; 95% CI 2.93-8.17, p < 0.001) but not neutropenia (HR 1.45; 95% CI 0.88-2.39, p = 0.135) were associated with mortality. Chronic kidney disease was also a significant predictor of death in the HM subgroup (HR 3.94; 95% CI 1.15-13.44, p = 0.028). Interpretation IA is identified in high number of patients with mild/no immunosuppression in our study. The relatively high proportion of non-A. fumigatus species complex isolates and 6.5% azole-resistance rate amongst A. fumigatus sensu stricto necessitates accurate species identification and susceptibility testing for optimal patient outcomes. Funding This work is unfunded. All authors' financial disclosures are listed in detail at the end of the manuscript.
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Affiliation(s)
- Shio Yen Tio
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- National Centre for Infections in Cancer, Melbourne, Australia
- Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
- School of Medicine, University of Sydney, Australia
| | - Kate Hamilton
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
| | - Christopher H. Heath
- Department of Microbiology, PathWest Laboratory Medicine, Murdoch, Western Australia, Australia
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Department of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Alyssa Pradhan
- Prince of Wales Hospital, Southeast Sydney LHD, NSW Health Pathology, Australia
- School of Medicine, University of Sydney, Australia
| | - Arthur J. Morris
- Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - Tony M. Korman
- Monash University and Monash Health, Clayton, Victoria, Australia
| | - Orla Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Catriona L. Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
- School of Medicine, University of Sydney, Australia
| | - Sarah Kidd
- National Mycology Reference Centre, Microbiology & Infectious Diseases, SA Pathology, Adelaide, South Australia, Australia
| | - Timothy Spelman
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Nadiya Brell
- Prince of Wales Hospital, Southeast Sydney LHD, NSW Health Pathology, Australia
- University of New South Wales, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Australia
| | - Julia E. Clark
- Infection Management Service, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane 4101, Australia
- School of Clinical Medicine, CHQCU, University of Queensland, Australia
| | - Katerina Mitsakos
- Department of Infectious Disease and Microbiology, Royal North Shore Hospital, Sydney, Australia
| | - Robyn P. Hardiman
- Department of Infectious Disease and Microbiology, Royal North Shore Hospital, Sydney, Australia
| | - Phoebe Williams
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Australia
- School of Public Health, Faculty of Medicine, The University of Sydney, Australia
| | - Anita J. Campbell
- Department of Infectious Diseases, Perth Children’s Hospital, Western Australia, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Western Australia, Australia
| | - Justin Beardsley
- University of Sydney Infectious Disease Institute, Australia
- Westmead Hospital, Western Sydney LHD, NSW Health, Australia
- Westmead Institute for Medical Research, Australia
| | - Sebastiaan Van Hal
- School of Medicine, University of Sydney, Australia
- Department of Infectious Diseases and Microbiology Royal Prince Alfred Hospital, Australia
| | - Michelle K. Yong
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- National Centre for Infections in Cancer, Melbourne, Australia
- Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - Leon J. Worth
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- National Centre for Infections in Cancer, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - Monica A. Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- National Centre for Infections in Cancer, Melbourne, Australia
- Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
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Approach to the diagnosis of invasive fungal infections of the respiratory tract in the immunocompromised host. Curr Opin Pulm Med 2023; 29:149-159. [PMID: 36917216 DOI: 10.1097/mcp.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
PURPOSE OF REVIEW The burden of invasive fungal infection is increasing worldwide, largely due to a growing population at-risk. Most serious human fungal pathogens enter the host via the respiratory tract. Early identification and treatment of invasive fungal respiratory infections (IFRIs) in the immunocompromised host saves lives. However, their accurate diagnosis is a difficult challenge for clinicians and mortality remains high. RECENT FINDINGS This article reviews IFRIs, focussing on host susceptibility factors, clinical presentation, and mycological diagnosis. Several new diagnostic tools are coming of age including molecular diagnostics and point-of-care antigen tests. As diagnosis of IFRI relies heavily on invasive procedures like bronchoalveolar lavage and lung biopsy, several novel noninvasive diagnostic techniques are in development, such as metagenomics, 'volatilomics' and advanced imaging technologies. SUMMARY Where IFRI cannot be proven, clinicians must employ a 'weights-of-evidence' approach to evaluate host factors, clinical and mycological data. Implementation studies are needed to understand how new diagnostic tools can be best applied within clinical pathways. Differentiating invasive infection from colonization and identifying antifungal resistance remain key challenges. As our diagnostic arsenal expands, centralized clinical mycology laboratories and efforts to ensure access to new diagnostics in low-resource settings will become increasingly important.
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Wan ER, Elands SA, Walsh SB. Post-transplantation cutaneous and renal Aspergillus infection. Int J Infect Dis 2023; 127:23-25. [PMID: 36462573 DOI: 10.1016/j.ijid.2022.11.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/24/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022] Open
Abstract
A renal transplant recipient aged 68 years experienced multiple complications after an initial good graft function from a deceased donor transplant. Late in the first week, the patient was oliguric with hematuria; the graft failed in week 2 after the development of a hematoma from a rupture of a renal artery aneurysm. He had a recurrent bleed from the internal iliac graft site and subsequently developed painful dark patches on his leg, distal to where the transplant had been. Histology from the explanted graft and skin biopsies demonstrated Aspergillus flavus; this was also grown in the culture of the external iliac artery tissue. Systemic aspergillosis is rare but well recognized, especially in the immunocompromised. Presentations include mycotic aneurysms and secondary cutaneous aspergillosis from hematogenous spread. Diagnosis requires confirmation by histology or direct culture, but a high β-glucan concentration and positive galactomannan antigen can suggest invasive fungal infection in the early stages of the disease. Cases should be managed with systemic antifungals and involvement of local microbiology services; unfortunately, the prognosis is poor.
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Affiliation(s)
- Elizabeth R Wan
- UCL Department of Renal Medicine, Royal Free Hospital, Rowland Hill Street, London, UK.
| | - Sophie A Elands
- UCL Department of Renal Medicine, Royal Free Hospital, Rowland Hill Street, London, UK.
| | - Stephen B Walsh
- UCL Department of Renal Medicine, Royal Free Hospital, Rowland Hill Street, London, UK.
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Kriegl L, Boyer J, Egger M, Hoenigl M. Antifungal stewardship in solid organ transplantation. Transpl Infect Dis 2022; 24:e13855. [PMID: 35593394 PMCID: PMC9786549 DOI: 10.1111/tid.13855] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/10/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Antifungal stewardship (AFS) has emerged as an important component of quality in managing invasive fungal infections (IFIs), and cost-benefit calculations suggest regular training in AFS is well worth the effort. METHODS This review will discuss the most common IFIs in solid organ transplantation (SOT)-recipients, how to diagnose them, and current recommendations for antifungal treatment and prophylaxis before demonstrating key takeaway points of AFS in this high-risk population. RESULTS Effective AFS starts before a patient is admitted for SOT, through education and regular interactions of the interdisciplinary clinical team involved in patient management, considering local factors such as epidemiological data and knowledge of diagnostic options including local turnaround times. Understanding the spectrum of antifungal agents, their efficacy and safety profiles, and pharmacokinetics, as well as duration of therapy is hereby essential. The most frequent IFIs in SOT recipients are caused by Candida species, followed by Aspergillus species, both with increasing resistance rates. Diagnosis of IFI can be challenging due to unspecific clinical presentation and difficult interpretation of microbiological findings and biomarkers. Prophylactic strategies, such as those for invasive aspergillosis in lung transplantation or invasive candidiasis (IC) in certain liver transplant settings, as well as the selection of the appropriate therapeutic agents require detailed knowledge on the pharmacokinetics and drug-drug interactions of antifungals. CONCLUSIONS Here in this review, we address what constitutes good AFS in this heterogeneous field of solid organ transplant recipients.
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Affiliation(s)
- Lisa Kriegl
- Division of Infectious DiseasesDepartment of Internal MedicineMedical University of GrazGrazAustria
| | - Johannes Boyer
- Division of Infectious DiseasesDepartment of Internal MedicineMedical University of GrazGrazAustria
| | - Matthias Egger
- Division of Infectious DiseasesDepartment of Internal MedicineMedical University of GrazGrazAustria,BioTechMed‐GrazGrazAustria
| | - Martin Hoenigl
- Division of Infectious DiseasesDepartment of Internal MedicineMedical University of GrazGrazAustria,BioTechMed‐GrazGrazAustria,Division of Infectious Diseases and Global Public HealthDepartment of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
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Calderón-Parra J, Moreno-Torres V, Mills-Sanchez P, Tejado-Bravo S, Romero-Sánchez I, Balandin-Moreno B, Calvo-Salvador M, Portero-Azorín F, García-Masedo S, Muñez-Rubio E, Ramos-Martinez A, Fernández-Cruz A. Association of COVID-19-Associated Pulmonary Aspergillosis with Cytomegalovirus Replication: A Case–control Study. J Fungi (Basel) 2022; 8:jof8020161. [PMID: 35205914 PMCID: PMC8877274 DOI: 10.3390/jof8020161] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 01/14/2023] Open
Abstract
Introduction: Cytomegalovirus (CMV) infection is a well-known factor associated with invasive aspergillosis in immunocompromised hosts. However, its association with COVID-19-associated pulmonary aspergillosis (CAPA) has not been described. We aimed to examine the possible link between CMV replication and CAPA occurrence. Methods: A single-center, retrospective case–control study was conducted. A case was defined as a patient diagnosed with CAPA according to 2020 ECMM/ISHAM consensus criteria. Two controls were selected for each case among critically ill COVID-19 patients. Results: In total, 24 CAPA cases were included, comprising 14 possible CAPA and 10 probable CAPA. Additionally, 48 matched controls were selected. CMV replication was detected more frequently in CAPA than in controls (75.0% vs. 35.4%, p = 0.002). Probable CMV end-organ disease was more prevalent in CAPA (20.8% vs. 4.2%, p = 0.037). After adjusting for possible confounding factors, CMV replication persisted strongly associated with CAPA (OR 8.28 95% CI 1.90–36.13, p = 0.005). Among 11 CAPA cases with CMV PCR available prior to CAPA, in 9 (81.8%) cases, CMV replication was observed prior to CAPA diagnosis. Conclusions: Among critically ill COVID-19 patients, CMV replication was associated with CAPA and could potentially be considered a harbinger of CAPA. Further studies are needed to confirm this association.
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Affiliation(s)
- Jorge Calderón-Parra
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (V.M.-T.); (P.M.-S.); (E.M.-R.); (A.R.-M.); (A.F.-C.)
- Research Institute Puerta de Hierro-Segovia de Aranda (IDIPHSA), 28222 Madrid, Spain
- Correspondence:
| | - Victor Moreno-Torres
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (V.M.-T.); (P.M.-S.); (E.M.-R.); (A.R.-M.); (A.F.-C.)
- Research Institute Puerta de Hierro-Segovia de Aranda (IDIPHSA), 28222 Madrid, Spain
| | - Patricia Mills-Sanchez
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (V.M.-T.); (P.M.-S.); (E.M.-R.); (A.R.-M.); (A.F.-C.)
| | - Sandra Tejado-Bravo
- Intensive Care Unit, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (S.T.-B.); (B.B.-M.)
| | - Isabel Romero-Sánchez
- Microbiology Service, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain;
| | - Bárbara Balandin-Moreno
- Intensive Care Unit, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (S.T.-B.); (B.B.-M.)
| | - Marina Calvo-Salvador
- Pharmacy Service, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (M.C.-S.); (F.P.-A.); (S.G.-M.)
| | - Francisca Portero-Azorín
- Pharmacy Service, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (M.C.-S.); (F.P.-A.); (S.G.-M.)
| | - Sarela García-Masedo
- Pharmacy Service, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (M.C.-S.); (F.P.-A.); (S.G.-M.)
| | - Elena Muñez-Rubio
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (V.M.-T.); (P.M.-S.); (E.M.-R.); (A.R.-M.); (A.F.-C.)
| | - Antonio Ramos-Martinez
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (V.M.-T.); (P.M.-S.); (E.M.-R.); (A.R.-M.); (A.F.-C.)
| | - Ana Fernández-Cruz
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (V.M.-T.); (P.M.-S.); (E.M.-R.); (A.R.-M.); (A.F.-C.)
- Research Institute Puerta de Hierro-Segovia de Aranda (IDIPHSA), 28222 Madrid, Spain
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Neutrophile-to-Lymphocyte Ratio as a Predictor of Mortality and Response to Treatment in Invasive Aspergillosis among Heart Transplant Recipients—Exploratory Study. Medicina (B Aires) 2021; 57:medicina57121300. [PMID: 34946245 PMCID: PMC8703887 DOI: 10.3390/medicina57121300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background and objective: Aspergillus pulmonary infections are potentially life-threatening complications that can occur after heart transplantation. The aim of the study was to find an easily available mortality predictor during Aspergillosis infection therapy following heart transplantation. Materials and methods: This study involved 15 heart recipients with the mean age of 55 ± 6 years who were diagnosed with invasive aspergillosis (IA) in a mean time of 80 ± 53 (19–209) days after orthotropic heart transplantation. Results: Out of fifteen patients diagnosed with IA, five died. The mean time from diagnosis to death in the deceased group was 28 ± 18 days. They were diagnosed with IA in a mean time of 80 ± 53 (19–209) days after orthotropic heart transplantation. During the initial seven days of therapy, the neutrophil to lymphocyte ratio (NLR) significantly differed between the two groups on day three and day seven, with median values of 10.8 [4.3–17.0] vs. 20.2 [17.4–116.8] (p = 0.0373) and 5.2 [3.2–8.1] vs. 32.2 [13.5–49.9] (p = 0.0101) in the survivor and the deceased group, respectively. The NLR was a significant predictor of death both on day three (cut-off point 17.2) and day seven (cut-off point 12.08) of therapy. Conclusions: Findings in our study indicate that NLR may be of predictive value in the estimation of mortality risk or response to treatment among patients with invasive aspergillosis following heart transplantation.
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A Comparative Analysis of Mucormycosis in Immunosuppressed Hosts Including Patients with Uncontrolled Diabetes in the Southwest United States. Am J Med 2021; 134:1155-1159. [PMID: 33974907 DOI: 10.1016/j.amjmed.2021.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Mucormycosis (zygomycosis) is an invasive fungal infection that carries a high risk of morbidity and mortality. Uncontrolled diabetes mellitus and other immunocompromising conditions are risk factors for mucormycosis development. We here describe the differences in characteristics and outcomes of mucormycosis among solid organ transplant, hematological malignancy, and diabetes mellitus groups at our institution. METHODS We conducted a retrospective chart review over the period of 2009-2020, with identifying patients using the International Classification of Diseases, Ninth and Tenth Revisions. Clinical, laboratory, and outcome data were collected. RESULTS There were 28 patients identified: 7 solid organ transplant, 3 hematological malignancy, and 18 diabetes mellitus patients were included in the study. Three solid organ transplant patients experienced an episode of rejection, and another 3 had cytomegalovirus infection prior to presenting with mucormycosis. Four of seven solid organ transplant patients had a history of diabetes mellitus, but the median hemoglobin A1C was lower than in the diabetes mellitus group (6.3 vs 11.5; P = .006). The mortality rate difference between solid organ transplant and diabetes mellitus was not statistically significant: 2/7 (28.57%) vs 5/18 (27.78%); P = .66. Patients with bilateral disease (pulmonary or sinus) had significantly higher mortality (80% vs 13%, P = .008). There was no difference in mortality outcomes among the different types of antifungal therapies administered. CONCLUSION A multispecialty approach is imperative in mucormycosis therapy. While the underlying risk factors were different, the outcomes were comparable for the solid organ transplant and diabetes mellitus groups. Future larger and longitudinal studies are recommended.
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Alshaqaq A, Al Abadi A, Altheaby A, Bukhari MA, Nasrallah B, Alamoudi A, Arabi Z, Alhejaili F, Saad KB, Busbaih A, Idris MA, Askandarani S, AlBugami MM, Alotaibi FE, Hamawi K, Akkari KB. Coronavirus Disease 2019 and Kidney Transplantation in Saudi Arabia: Outcomes and Future Opportunities. Ann Transplant 2021; 26:e931832. [PMID: 34083502 PMCID: PMC8186269 DOI: 10.12659/aot.931832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/29/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Kidney transplant services all over the world were severely impacted by the coronavirus disease 2019 pandemic. The optimum management of kidney transplant recipients with coronavirus disease 2019 remains uncertain. MATERIAL AND METHODS We conducted a multicenter cohort study of kidney transplant recipients with coronavirus disease 2019 infection in Saudi Arabia. Multivariable Cox regression analysis was used to study predictors of graft and patient outcomes at 28 days after coronavirus disease 2019 diagnosis. RESULTS We included 130 kidney transplant recipients, with a mean age of 48.7(±14.4) years. Fifty-nine patients were managed at home with daily follow-up utilizing a dedicated clinic, while 71 (54.6%) required hospital admission. Acute kidney injury occurred in 35 (26.9%) patients. Secondary infections occurred in 38 (29.2%) patients. SARS-CoV-2 antibodies testing was carried out in 84 patients, of whom 70 tested positive for IgG and/or IgM. Fourteen patients died (10.8%). A multivariable Cox regression analysis showed that age, creatinine at presentation, acute kidney injury, and use of azithromycin were significantly associated with worse patient survival. Graft loss was associated with requiring renal replacement therapy and development of secondary infections. CONCLUSIONS Despite kidney transplant recipients with coronavirus disease 2019 infection having higher rate of hospital admission and mortality compared to the general population, a significant number of them can be managed using a telemedicine clinic. Most kidney transplant patients seem to mount an antibody response following coronavirus disease 2019 infection, and it remains to be seen if they will have a similar response to the incoming vaccines.
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Affiliation(s)
- Ali Alshaqaq
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Abdulnaser Al Abadi
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Abdulrahman Altheaby
- Hepatobiliary Sciences and Organ Transplant Center, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | | | - Basil Nasrallah
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Alaa Alamoudi
- Kidney and Pancreas Transplant Department, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Ziad Arabi
- Hepatobiliary Sciences and Organ Transplant Center, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Fayez Alhejaili
- Hepatobiliary Sciences and Organ Transplant Center, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Khalid Bin Saad
- Hepatobiliary Sciences and Organ Transplant Center, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Ahmed Busbaih
- Critical Care Department, King Fahad Hospital, Hofuf, Saudi Arabia
| | - Mohammed Abdelrahim Idris
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Sumayah Askandarani
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Meteb M. AlBugami
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Fahad E. Alotaibi
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Khaled Hamawi
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Khalid Bel’eed Akkari
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
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Bretón-Martínez JR, Alcolea A, Quintero-García D, Méndez-Echevarria A, Ramos E, Bueno F, Colomina J, Marí-López J, Crehuá-Gaudiza E, García-Rodriguez J, Martínez-Costa C. Non-wild-type cryptococcosis in a child with multivisceral organ transplant who owned bird pets. Transpl Infect Dis 2021; 23:e13558. [PMID: 33386674 DOI: 10.1111/tid.13558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 02/06/2023]
Affiliation(s)
- José R Bretón-Martínez
- Department of Pediatrics, Hospital Clínico Universitario de Valencia, Valencia, Spain.,University of Valencia, Valencia, Spain
| | - Alida Alcolea
- Pediatric Gastroenterology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Ana Méndez-Echevarria
- Pediatric Infectious Diseases Department, Hospital Universitario La Paz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Esther Ramos
- Pediatric Gastroenterology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Felipe Bueno
- Department of Microbiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Javier Colomina
- Department of Microbiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Jorge Marí-López
- Department of Pediatrics, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Elena Crehuá-Gaudiza
- Department of Pediatrics, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Cecilia Martínez-Costa
- Department of Pediatrics, Hospital Clínico Universitario de Valencia, Valencia, Spain.,University of Valencia, Valencia, Spain
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