title: Risk factors, clinical characteristics, and outcomes of invasive fungal infections in solid organ transplant recipients.
abstract: BACKGROUND
  Invasive fungal infection (IFI) is an important cause of morbidity and mortality among solid organ transplant (SOT) recipients. We sought to assess risk factors, clinical characteristics, and current outcomes of IFI in SOT recipients.
  
  
  METHODS
  We reviewed all episodes of IFI occurring among SOT recipients in a university hospital from 2008 to 2011. To determine risk factors for IFI we carried out a matched case-control study (1:2 ratio). Control subjects were matched for transplant type and timing.
  
  
  RESULTS
  We documented 20 episodes of IFI among 744 SOT recipients (2.7%). Sixty-five percent of cases were proven IFI and 35% were probable IFI. The types of IFI documented were aspergillosis in 8 cases, candidiasis in 7, pneumocystosis in 3, Emmonsia species in infection 1, and disseminated cryptococcosis in 1. Ninety-nine percent of the patients had received a prior antibiotic therapy (3 months), 40% presented allograft rejection (3 months), and 40% had prior kidney injury. Complications of IFI included septic shock (50%), respiratory failure (55%), multiple-organ dysfunction (55%), and intensive care unit (ICU) admission (50%). Median days from transplantation to diagnosis was 103 for candidiasis (range, 27-4644) and 1195 for aspergillosis (range, 0-4319). In a comparison of case patients with 40 matched control subjects, case patients more frequently presented prior ICU stay (3 months; P = .05), hemodialysis requirement (P = .02), receipt of high-dose prednisone (6 months; P = .006), and prior antibiotic therapy (P < .001). Prior use of antibiotic treatment was the only risk factor for IFI (odds ratio [OR] 93; 95% confidence interval [CI], 8.3-1042). Case-fatality rate was 60%.
  
  
  CONCLUSIONS
  In our recent experience, 2.7% of SOT recipients developed IFI, mainly aspergillosis followed by candidiasis. Prior ICU admission, hemodialysis, receipt of high-dose prednisone, and prior antibiotic use were more frequent in cases when compared with control subjects, with the latter factor being the only independent risk factor for developing IFI. Case-fatality rate was high (60%).
authors.affiliation: Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain. martabodro@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Bodro
authors.forename: N
authors.initials: N
authors.lastname: Sabé
authors.forename: A
authors.initials: A
authors.lastname: Gomila
authors.forename: J
authors.initials: J
authors.lastname: Ayats
authors.forename: C
authors.initials: C
authors.lastname: Baliellas
authors.forename: J
authors.initials: J
authors.lastname: Roca
authors.forename: E
authors.initials: E
authors.lastname: Melilli
authors.forename: J
authors.initials: J
authors.lastname: Carratalà
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D016009:Chi-Square Distribution; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009181:Mycoses / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D016017:Odds Ratio; D016377:Organ Transplantation / Q000009:adverse effects* / Q000401:mortality; D010359:Patient Readmission; D011241:Prednisone / Q000009:adverse effects; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D011241:Prednisone