title: Incidence and outcome of fungal infections in pediatric small bowel transplant recipients.
abstract: BACKGROUND
  Data on the incidence, timing, and outcome of fungal infections in pediatric small bowel transplantation (SBT) are lacking.
  
  
  METHODS
  Cases of pediatric SBT from January 2003 through December 2007 were collected. Standard induction was with thymoglobulin and/or basiliximab and maintenance immunosuppression was a tacrolimus-based regimen. Chi-square was used for categorical variables and Kaplan-Meier for survival analyses.
  
  
  RESULTS
  A total 98 recipients were included; 25 patients developed 59 episodes of Candida infections and 4 episodes of invasive aspergillosis (incidence 25.5%, 95% confidence interval [CI] 17%, 34%). Of the Candida species, 37.3% were Candida albicans and 62.7% non-albicans Candida. Of all yeast infections, 66.1% were fungemia, 28.8% intra-abdominal infections, 1.7% empyema, and 3.4% urinary tract infection. Of the Candida intra-abdominal infections, 41.2% developed in the first month post transplantation, while 79.5% of candidemia developed after >6 months. Median time from transplantation to fungal infection was significantly shorter for abdominal infections compared with fungemia (9 versus 163 days; P=0.004). All-cause mortality was not significantly different between patients with and without fungal infections (32.3% versus 29.8%; odds ratio=1.12, 95% CI 0.45, 2.8).
  
  
  CONCLUSIONS
  Fungal infections occurred in 25% of SBT recipients and C. albicans was the most common species. Intra-abdominal fungal infections occurred earlier (<1 month) than fungemia (>6 months) post transplantation.
authors.affiliation: Department of Internal Medicine, Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, Nebraska 68198-5400, USA. dflorescu@unmc.edu
authors.forename: D F
authors.initials: DF
authors.lastname: Florescu
authors.forename: K M
authors.initials: KM
authors.lastname: Islam
authors.forename: W
authors.initials: W
authors.lastname: Grant
authors.forename: D F
authors.initials: DF
authors.lastname: Mercer
authors.forename: A
authors.initials: A
authors.lastname: Langnas
authors.forename: J
authors.initials: J
authors.lastname: Botha
authors.forename: B
authors.initials: B
authors.lastname: Nielsen
authors.forename: A C
authors.initials: AC
authors.lastname: Kalil
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D001230:Aspergillus / Q000145:classification / Q000302:isolation & purification; D002175:Candida / Q000145:classification / Q000302:isolation & purification; D002176:Candida albicans / Q000302:isolation & purification; D058387:Candidemia / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D058365:Candidiasis, Invasive / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents; D015994:Incidence; D007223:Infant; D007421:Intestine, Small / Q000637:transplantation*; D008297:Male; D009181:Mycoses / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality*; D019737:Transplants / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents