1582. Bronchoalveolar Lavage (BAL) Diagnosed Invasive Fungal Infections (IFIs) in Non-Lung Solid Organ Transplant (SOT) Recipients
Session: Poster Abstract Session: Mycology - There's a Fungus Among Us: Epidemiology
Friday, October 28, 2016
Room: Poster Hall
Background:Little is known regarding the incidence of Pneumocystis jirovecipneumonia (PJP) in SOT recipients since the implementation of universal prophylaxis. Furthermore, the impact of increased use of lymphocyte depleting agents as well as the introduction of alemtuzumab as an induction option is also unclear. To our knowledge, no studies exist evaluating such criterion. The purpose of this study was to evaluate the incidence of PJP and other BAL diagnosed IFIs at a high volume transplant center as well as to summarize PJP prophylaxis within this population.

Methods:All solid organ transplants occurring between January 2009 and July 2014 were cross referenced with a list of all BALs performed during the same timeframe. Exclusion criteria included patients less than 19 years of age, non-functioning graft at time of BAL, BAL prior to transplant, or status post lung transplant. Data collected included type of transplant, time from transplant, PJP prophylaxis at collection and 30 days prior to BAL, antifungal usage within previous 30 days, and presence or absence of IFI on BAL. For positive BALs, additional data was collected regarding known risk factors for IFIs.

Results:A total of 125 patients met inclusion criteria. Demographic data is presented in Table 1.

No BAL specimens were positive for PJP. Four specimens were positive and grew species of Aspergillus, Histoplasmosis, and Candida. A summary of risk factors present in positive cases can be found in Table 2. 

Two patients with IFIs expired within 1 year of collection and a third passed away after this time period. About half of evaluted patients were on prophylaxis at the time of BAL and Figure 1 illustrates the breakdown by organ and agent. Only 17% of patients had recieved an antifungal within the previous 30 days as summarized in Figure 2. Figure 1. Figure 2. Conclusion: Over a 5-year period, no cases of PJP were detected in our study. These findings are similar to estimations predicted given routine prophylaxis. As a result of such a low incidence, the necessity for prophylaxis or prolonged prophylaxis may warrant further research. Although they had serious consequences, small incidences of other IFIs were also noted in this population.

Adam Dodson, PharmD and Alexandra James, PharmD, BCPS, Department of Pharmacy, University of Alabama at Birmingham Hospital, Birmingham, AL


A. Dodson, None

A. James, None

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