Candida Blood Stream Infections Post Lung Transplant

Gadre, Shruti; Koval, Christine; Budev, Marie

doi:10.1016/j.healun.2017.01.637

Cited by 5 publications

(4 citation statements)

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“…It has been associated with significant morbidity and mortality. Some of the risk factors that has been associated with invasive candidemia are high dose steroids, immunomodulators, long term catheters, hospitalization prior to transplant, rejection, need for an open chest following the transplant procedure, and ECMO support post-transplant (12).…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…While uncommon, it is associated with high mortality (54.5%). Risk factors for this invasive infection include high dose steroids, immunomodulators, long term catheters, rejection, need for open chest, and ECMO support post-transplant (12). In addition to candidemia other manifestations include invasive disease, pleural space infections, and local anastomotic site infections (35).…”

Section: Other Fungal Infectionsmentioning

confidence: 99%

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Infection prophylaxis and management of fungal infections in lung transplant

Villalobos¹,

Husain²

2020

Ann Transl Med

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Lung transplantation has emerged as a lifesaving treatment for a wide range of advanced lung diseases. While the survival of lung transplant recipients continues to improve, infectious complications contribute substantially to morbidity and mortality following lung transplantation. The incidence of invasive fungal infections is variable, with a mean occurrence of 8.6%. The majority of fungal infections in lung transplant recipients are caused Aspergillus and Candida species. This review provides an update in the current approaches for the diagnosis, management and prevention of fungal infections and the late complications that are associated.

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Section: Clinical Manifestationsmentioning

confidence: 99%

Section: Other Fungal Infectionsmentioning

confidence: 99%

Infection prophylaxis and management of fungal infections in lung transplant

Villalobos¹,

Husain²

2020

Ann Transl Med

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“…For example, proton pump inhibitors (PPI), metoclopramide, and rifampicin lower drug concentrations, whereas macrolide antibiotics, amiodaron, ciprofloxacin, and some antiviral drugs raise the azole plasma concentration 3,10,11 . However, critically ill lung transplant recipients depend on an effective prophylaxis, as they have a high risk to develop a fungal infection, because the allograft is exposed to the environment and high steroid doses are administered; catheters further increase the risk of a fungal infection 1,12,13 . As a result, therapeutic drug monitoring (TDM) is recommended for both drugs 8,14‐16 .…”

Section: Introductionmentioning

confidence: 99%

“…3,10,11 However, critically ill lung transplant recipients depend on an effective prophylaxis, as they have a high risk to develop a fungal infection, because the allograft is exposed to the environment and high steroid doses are administered; catheters further increase the risk of a fungal infection. 1,12,13 As a result, therapeutic drug monitoring (TDM) is recommended for both drugs. 8,[14][15][16] The British Society of Mycology recommended a target concentration in steady state of ≥500 µg/L for itraconazole and ≥700 µg/L for posaconazole as prophylaxis.…”

Section: Introductionmentioning

confidence: 99%

Comparing posaconazole and itraconazole for antifungal prophylaxis in critically ill lung transplant recipients: Efficacy and plasma concentrations

Kallee

Scharf

Schroeder

et al. 2021

Transplant Infectious Dis

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Background Posaconazole and itraconazole are commonly used for systemic antifungal prophylaxis after lung transplantation. The aim of this study on critically ill lung transplant recipients was to assess the rate of adequate plasma concentrations and the frequency of fungal‐induced transitions from antifungal prophylaxis to therapy after the administration of either posaconazole or itraconazole for systemic prophylaxis. Methods Critically ill lung transplant recipients with postoperative posaconazole or itraconazole prophylaxis and therapeutic drug monitoring from February 2016 to November 2019 were retrospectively included in the study. Positive fungal cultures or Aspergillus antigen tests resulting in a transition from antifungal prophylaxis to therapy were analyzed from the first day of prophylaxis until 7 days after the last sample for each patient. Adequate plasma concentrations were defined as ≥500 µg/L for itraconazole and ≥700 µg/L for posaconazole. Results Two hundred seventy‐five samples from 73 patients were included in the analysis. Overall, 60% of the posaconazole and 55% of the itraconazole concentrations were subtherapeutic. Administration of posaconazole suspension resulted significantly (P < .01) more often in subtherapeutic concentrations than tablets (68% vs 10%). Patients treated with posaconazole showed less positive fungal records resulting in a transition from prophylaxis to therapy than patients treated with itraconazole (10% vs 33%, P‐value: .029). The detection of a fungal pathogen was not associated with the measured plasma concentrations or the achievement of the target concentrations. Conclusion Our findings suggest that posaconazole should be used instead of itraconazole for systemic prophylaxis in critically ill lung transplant recipients.

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Fungal Infections in Lung Transplantation

2022

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Purpose of Review We aim to understand the most common fungal infections associated with the post-lung transplant period, how to diagnose, treat, and prevent them based on the current guidelines published and our center’s experience. Recent Findings Different fungi inhabit specific locations. Diagnosis of invasive fungal infections (IFIs) depends on symptoms, radiologic changes, and a positive microbiological or pathology data. There are several molecular tests that have been used for diagnosis. Exposure to fungal prophylaxis can predispose lung transplant recipients to these emerging molds. Understanding and managing medication interactions and drug monitoring are essential in successfully treating IFIs. Summary With the increasing rate of lung transplantations being performed, and the challenges posed by the immunosuppressive regimen, understanding the risk and managing the treatment of fungal infections are imperative to the success of a lung transplant recipient. There are many ongoing clinical trials being conducted in hopes of developing novel antifungals.

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Candida Blood Stream Infections Post Lung Transplant

Cited by 5 publications

References 0 publications

Infection prophylaxis and management of fungal infections in lung transplant

Infection prophylaxis and management of fungal infections in lung transplant

Comparing posaconazole and itraconazole for antifungal prophylaxis in critically ill lung transplant recipients: Efficacy and plasma concentrations

Fungal Infections in Lung Transplantation

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