Skip to main content
Journal cover image

Invasive Fungal Infection After Lung Transplantation: Epidemiology in the Setting of Antifungal Prophylaxis.

Publication ,  Journal Article
Baker, AW; Maziarz, EK; Arnold, CJ; Johnson, MD; Workman, AD; Reynolds, JM; Perfect, JR; Alexander, BD
Published in: Clin Infect Dis
January 1, 2020

BACKGROUND: Lung transplant recipients commonly develop invasive fungal infections (IFIs), but the most effective strategies to prevent IFIs following lung transplantation are not known. METHODS: We prospectively collected clinical data on all patients who underwent lung transplantation at a tertiary care academic hospital from January 2007-October 2014. Standard antifungal prophylaxis consisted of aerosolized amphotericin B lipid complex during the transplant hospitalization. For the first 180 days after transplant, we analyzed prevalence rates and timing of IFIs, risk factors for IFIs, and data from IFIs that broke through prophylaxis. RESULTS: In total, 156 of 815 lung transplant recipients developed IFIs (prevalence rate, 19.1 IFIs per 100 surgeries, 95% confidence interval [CI] 16.4-21.8%). The prevalence rate of invasive candidiasis (IC) was 11.4% (95% CI 9.2-13.6%), and the rate of non-Candida IFIs was 8.8% (95% CI 6.9-10.8%). First episodes of IC occurred a median of 31 days (interquartile range [IQR] 16-56 days) after transplant, while non-Candida IFIs occurred later, at a median of 86 days (IQR 40-121 days) after transplant. Of 169 IFI episodes, 121 (72%) occurred in the absence of recent antifungal prophylaxis; however, IC and non-Candida breakthrough IFIs were observed, most often representing failures of micafungin (n = 16) and aerosolized amphotericin B (n = 24) prophylaxis, respectively. CONCLUSIONS: Lung transplant recipients at our hospital had high rates of IFIs, despite receiving prophylaxis with aerosolized amphotericin B lipid complex during the transplant hospitalization. These data suggest benefit in providing systemic antifungal prophylaxis targeting Candida for up to 90 days after transplant and extending mold-active prophylaxis for up to 180 days after surgery.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

January 1, 2020

Volume

70

Issue

1

Start / End Page

30 / 39

Location

United States

Related Subject Headings

  • Microbiology
  • Micafungin
  • Lung Transplantation
  • Invasive Fungal Infections
  • Humans
  • Candidiasis
  • Antifungal Agents
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences
  • 06 Biological Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Baker, A. W., Maziarz, E. K., Arnold, C. J., Johnson, M. D., Workman, A. D., Reynolds, J. M., … Alexander, B. D. (2020). Invasive Fungal Infection After Lung Transplantation: Epidemiology in the Setting of Antifungal Prophylaxis. Clin Infect Dis, 70(1), 30–39. https://doi.org/10.1093/cid/ciz156
Baker, Arthur W., Eileen K. Maziarz, Christopher J. Arnold, Melissa D. Johnson, Adrienne D. Workman, John M. Reynolds, John R. Perfect, and Barbara D. Alexander. “Invasive Fungal Infection After Lung Transplantation: Epidemiology in the Setting of Antifungal Prophylaxis.Clin Infect Dis 70, no. 1 (January 1, 2020): 30–39. https://doi.org/10.1093/cid/ciz156.
Baker AW, Maziarz EK, Arnold CJ, Johnson MD, Workman AD, Reynolds JM, et al. Invasive Fungal Infection After Lung Transplantation: Epidemiology in the Setting of Antifungal Prophylaxis. Clin Infect Dis. 2020 Jan 1;70(1):30–9.
Baker, Arthur W., et al. “Invasive Fungal Infection After Lung Transplantation: Epidemiology in the Setting of Antifungal Prophylaxis.Clin Infect Dis, vol. 70, no. 1, Jan. 2020, pp. 30–39. Pubmed, doi:10.1093/cid/ciz156.
Baker AW, Maziarz EK, Arnold CJ, Johnson MD, Workman AD, Reynolds JM, Perfect JR, Alexander BD. Invasive Fungal Infection After Lung Transplantation: Epidemiology in the Setting of Antifungal Prophylaxis. Clin Infect Dis. 2020 Jan 1;70(1):30–39.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

January 1, 2020

Volume

70

Issue

1

Start / End Page

30 / 39

Location

United States

Related Subject Headings

  • Microbiology
  • Micafungin
  • Lung Transplantation
  • Invasive Fungal Infections
  • Humans
  • Candidiasis
  • Antifungal Agents
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences
  • 06 Biological Sciences