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Risk Factors, Clinical Characteristics, and Outcomes of Invasive Fungal Infections in Solid Organ Transplant Recipients
- Source :
- Transplantation Proceedings. 44:2682-2685
- Publication Year :
- 2012
- Publisher :
- Elsevier BV, 2012.
-
Abstract
- Invasive fungal infection (IFI) is an important cause of morbidity and mortality among solid organ transplant (SOT) recipients. We sought to assess risk factors, clinical characteristics, and current outcomes of IFI in SOT recipients.We reviewed all episodes of IFI occurring among SOT recipients in a university hospital from 2008 to 2011. To determine risk factors for IFI we carried out a matched case-control study (1:2 ratio). Control subjects were matched for transplant type and timing.We documented 20 episodes of IFI among 744 SOT recipients (2.7%). Sixty-five percent of cases were proven IFI and 35% were probable IFI. The types of IFI documented were aspergillosis in 8 cases, candidiasis in 7, pneumocystosis in 3, Emmonsia species in infection 1, and disseminated cryptococcosis in 1. Ninety-nine percent of the patients had received a prior antibiotic therapy (3 months), 40% presented allograft rejection (3 months), and 40% had prior kidney injury. Complications of IFI included septic shock (50%), respiratory failure (55%), multiple-organ dysfunction (55%), and intensive care unit (ICU) admission (50%). Median days from transplantation to diagnosis was 103 for candidiasis (range, 27-4644) and 1195 for aspergillosis (range, 0-4319). In a comparison of case patients with 40 matched control subjects, case patients more frequently presented prior ICU stay (3 months; P = .05), hemodialysis requirement (P = .02), receipt of high-dose prednisone (6 months; P = .006), and prior antibiotic therapy (P.001). Prior use of antibiotic treatment was the only risk factor for IFI (odds ratio [OR] 93; 95% confidence interval [CI], 8.3-1042). Case-fatality rate was 60%.In our recent experience, 2.7% of SOT recipients developed IFI, mainly aspergillosis followed by candidiasis. Prior ICU admission, hemodialysis, receipt of high-dose prednisone, and prior antibiotic use were more frequent in cases when compared with control subjects, with the latter factor being the only independent risk factor for developing IFI. Case-fatality rate was high (60%).
- Subjects :
- Adult
Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Aspergillosis
Patient Readmission
law.invention
Hospitals, University
Renal Dialysis
Risk Factors
law
Internal medicine
Odds Ratio
Pneumocystosis
medicine
Humans
Risk factor
Aged
Retrospective Studies
Transplantation
Chi-Square Distribution
business.industry
Septic shock
Retrospective cohort study
Organ Transplantation
Middle Aged
medicine.disease
Intensive care unit
Anti-Bacterial Agents
Surgery
Intensive Care Units
Logistic Models
Treatment Outcome
Mycoses
Multivariate Analysis
Prednisone
Female
Hemodialysis
business
Immunosuppressive Agents
Subjects
Details
- ISSN :
- 00411345
- Volume :
- 44
- Database :
- OpenAIRE
- Journal :
- Transplantation Proceedings
- Accession number :
- edsair.doi.dedup.....ae89ef7c2f892ebf1d65484436382152