Epidemiology of invasive fungal infections in lung transplant recipients on long-term azole antifungal prophylaxis

Pearlie P. Chong, Cassie C. Kennedy, Matthew A. Hathcock, Walter K. Kremers, Raymund R. Razonable

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Lung transplant recipients (LTR) at our institution receive prolonged and mostly lifelong azole antifungal (AF) prophylaxis. The impact of this prophylactic strategy on the epidemiology and outcome of invasive fungal infections (IFI) is unknown. This was a single-center, retrospective cohort study. We reviewed the medical records of all adult LTR from January 2002 to December 2011. Overall, 16.5% (15 of 91) of patients who underwent lung transplantation during this time period developed IFI. Nineteen IFI episodes were identified (eight proven, 11 probable), 89% (17 of 19) of which developed during AF prophylaxis. LTR with idiopathic pulmonary fibrosis were more likely to develop IFI (HR: 4.29; 95% CI: 1.15-15.91; p = 0.03). A higher hazard of mortality was observed among those who developed IFI, although this was not statistically significant (hazard ratio [HR]: 1.71; 95% confidence interval [CI] [0.58-4.05]; p = 0.27). Aspergillus fumigatus was the most common cause of IFI (45%), with pulmonary parenchyma being the most common site of infection. None of our patients developed disseminated invasive aspergillosis, cryptococcal or endemic fungal infections. IFI continue to occur in LTR, and the eradication of IFI appears to be challenging even with prolonged prophylaxis. Azole resistance is uncommon despite prolonged AF exposure.

Original languageEnglish (US)
Pages (from-to)311-318
Number of pages8
JournalClinical Transplantation
Volume29
Issue number4
DOIs
StatePublished - Jan 1 2015

Fingerprint

Azoles
Epidemiology
Lung
Confidence Intervals
Idiopathic Pulmonary Fibrosis
Aspergillus fumigatus
Aspergillosis
Lung Transplantation
Invasive Fungal Infections
Transplant Recipients
Mycoses
Medical Records
Cohort Studies
Retrospective Studies
Mortality
Infection

Keywords

  • Antifungal prophylaxis
  • Azole resistance
  • Fungal infections
  • Itraconazole
  • Lung transplantation
  • Therapeutic drug monitoring

ASJC Scopus subject areas

  • Transplantation

Cite this

Epidemiology of invasive fungal infections in lung transplant recipients on long-term azole antifungal prophylaxis. / Chong, Pearlie P.; Kennedy, Cassie C.; Hathcock, Matthew A.; Kremers, Walter K.; Razonable, Raymund R.

In: Clinical Transplantation, Vol. 29, No. 4, 01.01.2015, p. 311-318.

Research output: Contribution to journalArticle

Chong, Pearlie P. ; Kennedy, Cassie C. ; Hathcock, Matthew A. ; Kremers, Walter K. ; Razonable, Raymund R. / Epidemiology of invasive fungal infections in lung transplant recipients on long-term azole antifungal prophylaxis. In: Clinical Transplantation. 2015 ; Vol. 29, No. 4. pp. 311-318.
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