Premium
Epidemiology of invasive respiratory disease caused by emerging non‐ Aspergillus molds in lung transplant recipients
Author(s) -
Peghin M.,
Monforte V.,
MartinGomez M.T.,
RuizCamps I.,
Berastegui C.,
Saez B.,
Riera J.,
Solé J.,
Gavaldá J.,
Roman A.
Publication year - 2016
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/tid.12492
Subject(s) - aspergillus , lung transplantation , medicine , transplantation , aspergillus fumigatus , microbiology and biotechnology , aspergillosis , incidence (geometry) , amphotericin b , interquartile range , immunology , biology , antifungal , physics , optics
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.