1522. Epidemiology of Invasive Fungal Infections (IFI) in Lung Transplant Recipients on Long Term Antifungal Prophylaxis
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • Epidemiology of Invasive Fungal Infections (IFI).pdf (784.8 kB)
  • Background: Data regarding contemporary epidemiology of invasive fungal infections (IFI) in lung transplant recipients (LTR) receiving prolonged antifungal (AF) prophylaxis (PPX) is lacking.

    Methods: The transplant database was reviewed for all lung transplants performed between 2002 to 2011. Patients were identified according to the EORTC criteria for proven or probable  IFI. Possible cases were excluded. All LTR received AF for a duration of one year to lifelong. 

    Results: 15 of 90 LTR developed proven or probable IFI in spite of AF PPX. The cumulative incidence of IFI was 16%, 24% and 29% at 1, 3 and 5 years post-transplantation respectively. A total of 19 IFI episodes were identified, with the most common site being pulmonary parenchyma (n=11 [58%]), followed by tracheobronchitis (n=4 [21%]), sinusitis, fungemia and intra-abdominal abscess (n=1 each). 1 patient had both tracheobronchial and pulmonary involvement. Of the 17 LTR with sinopulmonary IFI; 6 were proven and 11 were probable cases. All but 1 patient had positive cultures. Aspergillus fumigatus (n=9) was most common organism, followed by Aspergillus versicolor (n=4), Fusarium sp. (n=2), Candida glabrata (n=2), Aspergillus terreus (n=1), Rhizopus sp. (n=1), and Scopulariopsis sp. (n=1). 2 IFI episodes were caused by > 1 Aspergillus sp.

    Most IFI (n=11 [65%]) developed on itraconazole, followed by voriconazole (VRC) (n=5 [29%]) and posaconazole (n=1 [6%]) PPX. Of the 12 IFI for which AF trough levels were available, 4 (33.3%) were subtherapeutic. 2 isolates: A. fumigatus and C. glabrata, were found to be VRC (MIC = 4 µg/mL) and azole-resistant respectively. The IFI caused by Rhizopus sp. (which developed on VRC PPX) was likely donor-derived due to positive donor cultures and early onset (27 days). Treatment consisted mostly of either combination AF therapy (n=8 [42%]), or a different AF from that used for PPX (n=9 [47%]).  Most patients (n=10 [67%]) who developed IFI survived the infection.

    Conclusion: IFI continue to occur in LTR in spite of prolonged AF PPX. Although some of these breakthrough infections may be attributed to azole-resistant fungal organisms and subtherapeutic AF trough levels, reason(s) for development of the remaining IFI remains to be defined.

    Pearlie Chong, MD, Department of Medicine, Mayo Clinic, Rochester, MN, Cassie Kennedy, MD, Department of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN and Raymund Razonable, MD, Department of Medicine ID, Mayo Clinic, Rochester, MN


    P. Chong, None

    C. Kennedy, None

    R. Razonable, None

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