Outcomes of solid organ transplant recipients with invasive aspergillosis and other mold infections

Abstract

Objectives To characterize the clinical presentation and outcomes of invasive mold infections (IMI) in solid organ transplant (SOT) recipients. Methods Inclusion of all SOT recipients with IMI diagnosed between 2008 and 2016 at a referral center for SOT. Univariable analyses identified factors associated with death at one year, and logistic regression models retained independent predictors. Results Of the 1739 patients that received a SOT during this period, 68 developed IMI (invasive aspergillosis [IA] in 58). Cumulative incidence of IMI at 1 year ranged from 1.2% to 18.8% (kidney and heart transplantation, respectively). At baseline, compared with other IMI, the need for vasoactive drugs was more frequent in patients with IA. During follow‐up, 35 patients (51%) were admitted to the ICU and required mechanical ventilation (n = 27), vasoactive drugs (n = 31), or renal replacement therapy (n = 31). The need for vasoactive drugs (OR 7.34; P = .003) and a positive direct examination (OR 10.1; P = .004) were independently associated with the risk of death at 1 year in patients with IA (n = 33; 57%) Conclusions Characteristics of IMI at presentation varied according to the underlying transplanted organ and the mold species. Following IA, one‐year mortality may be predicted by the need for hemodynamic support and initial fungal load.

Patient notification about suspected hospital-associated outbreaks of invasive mold infections: Considerations for public health and hospital personnel

“…Given the multiple testing modalities, creating case definitions and performing laboratorybased case finding can be complex. No simple test exists for reliably diagnosing IMI 39,40 because a positive laboratory test can signify infection or colonization, necessitating additional contextual information in many cases. IMIs are among the most common missed diagnoses among ICU patients; 41 delays in diagnosis can increase the severity and mortality of IMIs.…”

Characterization of biodiversity of filamentous fungi in the soil of public spaces in João Pessoa, Northeast of Brazil

“…Although fungi develop beneficial actions for the environment and the vast majority have limited pathogenicity, in certain circumstances, these microorganisms may cause infections in humans, ranging from superficial lesions on the skin, hair and nails, even cases pulmonary diseases and disseminated infections, which can lead to individual to death (Barbieri & Ishida, 2016;Farges, et al, 2020).…”

Weekly high‐dose liposomal amphotericin B prevents invasive aspergillosis after heart transplantation

“…Among solid organ transplant (SOT) recipients, heart recipients are at a very high risk of developing IA, leading to a high mortality rate at 12 months posttransplantation, that is, up to 56%. 1 The heterogeneous incidence of IA among transplant centers and overtime according to environmental exposure precluded the development of firm consensus guidelines of preventive strategies for IA. In some centers, universal antifungal prophylaxis is given, while other centers opt for prophylaxis in selected patients according to the presence of risk factors for IA, such as acute rejection therapy, cytomegalovirus infection, neutropenia, renal replacement therapy, hypogammaglobulinemia, or previous colonization with Aspergillus sp.…”

“…Invasive aspergillosis (IA) is a life‐threatening fungal infection that develops due to an imbalance between host defenses (immunodeficiency) and environmental exposure to Aspergillus species. Among solid organ transplant (SOT) recipients, heart recipients are at a very high risk of developing IA, leading to a high mortality rate at 12 months posttransplantation, that is, up to 56% 1 …”