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Incidence and outcome of fungal infections in pediatric small bowel transplant recipients
Author(s) -
Florescu D.F.,
Islam K.M.,
Grant W.,
Mercer D.F.,
Langnas A.,
Botha J.,
Nielsen B.,
Kalil A.C.
Publication year - 2010
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/j.1399-3062.2010.00542.x
Subject(s) - medicine , fungemia , thymoglobulin , incidence (geometry) , transplantation , basiliximab , gastroenterology , odds ratio , immunosuppression , candida albicans , surgery , tacrolimus , mycosis , microbiology and biotechnology , biology , optics , physics
D.F. Florescu, K.M. Islam, W. Grant, D.F. Mercer, A. Langnas, J. Botha, B. Nielsen, A.C. Kalil. Incidence and outcome of fungal infections in pediatric small bowel transplant recipients.
Transpl Infect Dis 2010: 12: 497–504. All rights reserved. Background. Data on the incidence, timing, and outcome of fungal infections in pediatric small bowel transplantation (SBT) are lacking. Methods. Cases of pediatric SBT from January 2003 through December 2007 were collected. Standard induction was with thymoglobulin and/or basiliximab and maintenance immunosuppression was a tacrolimus‐based regimen. Chi‐square was used for categorical variables and Kaplan–Meier for survival analyses. Results. A total 98 recipients were included; 25 patients developed 59 episodes of Candida infections and 4 episodes of invasive aspergillosis (incidence 25.5%, 95% confidence interval [CI] 17%, 34%). Of the Candida species, 37.3% were Candida albicans and 62.7% non‐ albicans Candida . Of all yeast infections, 66.1% were fungemia, 28.8% intra‐abdominal infections, 1.7% empyema, and 3.4% urinary tract infection. Of the Candida intra‐abdominal infections, 41.2% developed in the first month post transplantation, while 79.5% of candidemia developed after >6 months. Median time from transplantation to fungal infection was significantly shorter for abdominal infections compared with fungemia (9 versus 163 days; P =0.004). All‐cause mortality was not significantly different between patients with and without fungal infections (32.3% versus 29.8%; odds ratio=1.12, 95% CI 0.45, 2.8). Conclusion. Fungal infections occurred in 25% of SBT recipients and C. albicans was the most common species. Intra‐abdominal fungal infections occurred earlier (<1 month) than fungemia (>6 months) post transplantation.