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Epidemiology of Invasive Candidiasis in Lung Transplant Recipients at a Large Transplant Center

F. J. Marco Canosa1, J. A. Morillas1, H. Hassouna2, K. Brizendine1

1Infectious Disease Department, Cleveland Clinic Foundation, Cleveland, OH, 2Division of Infectious Disease, Spectrum Health Medical Group, Grand Rapids, MI

Meeting: 2020 American Transplant Congress

Abstract number: B-284

Keywords: Fungal infection, Lung transplantation

Session Information

Session Name: Poster Session B: Lung: All Topics

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Invasive candidiasis (IC) represents the most common fungal infection in lung transplant recipients (LTR) early post-transplant. Universal antifungal prophylaxis is frequently employed, which may be associated with IC due to more resistant Candida species.

*Methods: We performed a single-center retrospective cohort study in LTR from 2012-2017. We reviewed the results of all positive cultures for Candida post-lung transplant to identify episodes of IC. As per protocol, LTR receive universal prophylaxis with systemic triazole for 18 months and initial aerosolized amphotericin B (AmB). Proven and probable IC were defined by criteria established by Mycoses Study Group, the European Confederation of Medical Mycology and the International Society for Heart and Lung Transplantation.

*Results: 523 LTR were reviewed. 16 (3%) patients developed a total of 22 breakthrough episodes of IC (19 proven and 3 probable). 11 (69%) patients were double lung transplant; 1 heart-lung. Median time from transplant to first episode of IC was 33 days (IQR 11-139). Candidemia was the most common presentation (12/22, 54.5%), followed by deep necrotic surgical site infection (18.2%), empyema (13.6%), mediastinitis (4.5%), intra-abdominal collection (4.5%) and necrotizing pneumonia (4.5%). No case of proven or probable tracheobronchitis or anastomosis infection was documented. With regard to infecting organism, C. glabrata was most common (13/22, 59%), followed by C. albicans (6/22, 27%), C. tropicalis (1), C. krusei (1), and C. kefyr (1). 3 bloodstream infections appeared to be secondary to intra-abdominal collection (1), empyema (1), and sternal abscess (1). Despite universal prophylaxis, breakthrough episodes of IC occurred while on itraconazole (18/22), AmB alone (2/22), voriconazole (1/22), and posaconazole (1/22). Azole levels prior to IC were documented only in 6 episodes and 5/6 (83%) were sub-therapeutic. 9/13 (69%) C. glabrata isolates showed fluconazole resistance (MIC≥64); 4 (31%) were susceptible dose dependent (MIC≤32). 1 LTR had 2 episodes of candidemia secondary to C. glabrata intermediate to micafungin (MIC 0.12). Ninety-day mortality for LTR with IC was 10/16 (62.5%) with 70% of them in LTR who had IC caused by non-albicans species.

*Conclusions: Overall prevalence of IC in the setting of universal prophylaxis is low. However, breakthrough episodes with more resistant non-albicans Candida species and the resultant high mortality are concerning. Transplant center-specific data on IC epidemiology are critical to delineate the duration and choice of antifungal prophylactic agent.

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To cite this abstract in AMA style:

Canosa FJMarco, Morillas JA, Hassouna H, Brizendine K. Epidemiology of Invasive Candidiasis in Lung Transplant Recipients at a Large Transplant Center [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/epidemiology-of-invasive-candidiasis-in-lung-transplant-recipients-at-a-large-transplant-center/. Accessed May 11, 2025.

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