Epidemiology of invasive respiratory disease caused by emerging non‐ Aspergillus molds in lung transplant recipients

Objectives Our aim was to assess the impact of positive cultures for non‐ Aspergillus molds on the risk of progression to invasive fungal infection ( IFI ), and the effect of prophylactic nebulized liposomal amphotericin B (n‐ LAB ) on these pathogens. Methods This was an observational study (2003–2013) including lung transplant recipients ( LTR ) receiving lifetime n‐ LAB prophylaxis, in whom non‐ Aspergillus molds were isolated on respiratory culture before and after transplantation (minimum 1‐year follow‐up). Results We studied 412 patients, with a mean postoperative follow‐up of 2.56 years (interquartile range 1.01–4.65). Pre‐ and post‐transplantation respiratory samples were frequently positive for non‐ A spergillus molds (11.9% and 16.9% of LTR respectively). Post transplantation, 10 (2.42%) patients developed non‐ A spergillus mold infection (4 S cedosporium species, 4 P urpureocillium species, 1 P enicillium species, and 1 S copulariopsis species); 5 (1.21%) had IFI , with 60% IFI ‐related mortality. Non‐ A spergillus molds with intrinsic amphotericin B ( AB ) resistance were more commonly isolated in bronchoscopy samples than AB ‐variably sensitive or AB ‐sensitive molds (54.5% vs. 25%, P = 0.04) and were associated with a higher risk of infection (56.3% vs. 1.3%%, P < 0.01). Conclusions In LTR undergoing n‐ LAB prophylaxis, pre‐ and post‐transplantation isolation of non‐ Aspergillus molds is frequent, but IFI incidence (1.21%) is low. P urpureocillium is an emerging mold. AB‐resistant non‐ A spergillus species were found more often in bronchoscopy samples and were associated with a higher risk of infection.