1526. Post-Transplant Infections: Results from a Modified Prospective Cohort Study
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Advances in the field are altering the epidemiology and outcomes of infections in solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients. To better understand these changes we are performing a modified prospective cohort study that longitudinally captures the epidemiology, treatment and outcomes of infections in such patients at our hospital. Herein we present interim results relating to invasive fungal infections (IFI) in the initial 14 months of this study.

Methods: Patients undergoing SOT and HSCT at Johns Hopkins Hospital, beginning January 1, 2012, are recruited to participate in this study. Consenting participants are followed at 3 months intervals. Information relating to underlying disease, transplantation, infections, antimicrobials and complications is collected by reviewing electronic medical records and by contacting the participants directly. Standardized definitions are used to code infectious outcomes. Data are stored and managed using REDCap.  

Results:

To date, 307 SOT and 230 (178 allogeneic and 52 autologous) HSCT recipients have been enrolled. Consent rates are 90.6% for SOT and 78.5% for HSCT. Validated data are available for outcomes related to invasive fungal infections.  Fifteen episodes of proven or probable IFI in 14 HSCT (13 allogeneic and 1 autologous) and 5 SOT recipients were confirmed (1 each: heart, lung, kidney, liver, kidney/liver). Attack rates are 7.3% for allo-HSCT, 2% auto-HSCT, 1.6% SOT. In HSCT there were 9 patients with aspergillosis, 5 with candidiasis and 1 with mucormycosis. 9/15 occurred within 3 months of HSCT and overall mortality was 57%. In SOT there were 4 with candidiasis and 1 with aspergillosis. All occurred within 3 months of transplant and none died.

Conclusion:

This modified prospective cohort study is providing important longitudinal data regarding the epidemiology and outcomes of invasive infections in SOT and HSCT recipients.  Important features of this study include standardized definitions, and prospective capture of data. Future analyses focus on bacterial and viral infections; efforts are currently directed on expanding the study to multiple centers in order to optimize conclusions drawn from real-world experience.

Shmuel Shoham, MD1, Na Lu1, Dionissios Neofytos, MD, MPH2, Darin Ostrander, PhD3, Robin Avery, MD1 and Kieren A. Marr, MD, FIDSA4, (1)Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, (2)Johns Hopkins, Baltimore, MD, (3)The Johns Hopkins Hospital, Baltimore, MD, (4)Medicine & Oncology, The Johns Hopkins Hospital, Baltimore, MD

Disclosures:

S. Shoham, Pfizer: Investigator, Research grant and Research support
Astellas: Investigator and Scientific Advisor, Consulting fee, Research grant and Research support
Merck: Investigator and Scientific Advisor, Research grant and Research support

N. Lu, Astellas: Investigator, Research grant and Research support

D. Neofytos, pfizer: Investigator, Research grant and Research support
merck: Investigator, Research grant and Research support
astellas: Investigator and Scientific Advisor, Consulting fee, Research grant and Research support

D. Ostrander, pfizer: Investigator, Research grant and Research support
merck: Investigator, Research grant and Research support
astellas: Investigator, Research grant and Research support

R. Avery, Pfizer: Investigator, Research grant and Research support
Merck: Investigator, Research grant and Research support
Astellas: Investigator, Research grant and Research support

K. A. Marr, Pfizer: Investigator, Research grant and Research support
Astellas: Investigator and Scientific Advisor, Consulting fee, Research grant and Research support
Merck: Investigator, Research grant and Research support

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.