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Epidemiology of invasive fungal infections in lung transplant recipients on long‐term azole antifungal prophylaxis
Author(s) -
Chong Pearlie P.,
Kennedy Cassie C.,
Hathcock Matthew A.,
Kremers Walter K.,
Razonable Raymund R.
Publication year - 2015
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12516
Subject(s) - medicine , hazard ratio , lung transplantation , aspergillosis , retrospective cohort study , epidemiology , azole , transplantation , aspergillus fumigatus , mycosis , surgery , confidence interval , immunology , antifungal , dermatology
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.