title: Epidemiology of invasive respiratory disease caused by emerging non-Aspergillus molds in lung transplant recipients.
abstract: OBJECTIVE
  Our aim was to assess the impact of positive cultures for non-Aspergillus molds on the risk of progression to invasive fungal infection (IFI), and the effect of prophylactic nebulized liposomal amphotericin B (n-LAB) on these pathogens.
  
  
  METHODS
  This was an observational study (2003-2013) including lung transplant recipients (LTR) receiving lifetime n-LAB prophylaxis, in whom non-Aspergillus molds were isolated on respiratory culture before and after transplantation (minimum 1-year follow-up).
  
  
  RESULTS
  We studied 412 patients, with a mean postoperative follow-up of 2.56 years (interquartile range 1.01-4.65). Pre- and post-transplantation respiratory samples were frequently positive for non-Aspergillus molds (11.9% and 16.9% of LTR respectively). Post transplantation, 10 (2.42%) patients developed non-Aspergillus mold infection (4 Scedosporium species, 4 Purpureocillium species, 1 Penicillium species, and 1 Scopulariopsis species); 5 (1.21%) had IFI, with 60% IFI-related mortality. Non-Aspergillus molds with intrinsic amphotericin B (AB) resistance were more commonly isolated in bronchoscopy samples than AB-variably sensitive or AB-sensitive molds (54.5% vs. 25%, P = 0.04) and were associated with a higher risk of infection (56.3% vs. 1.3%%, P < 0.01).
  
  
  CONCLUSIONS
  In LTR undergoing n-LAB prophylaxis, pre- and post-transplantation isolation of non-Aspergillus molds is frequent, but IFI incidence (1.21%) is low. Purpureocillium is an emerging mold. AB-resistant non-Aspergillus species were found more often in bronchoscopy samples and were associated with a higher risk of infection.
authors.affiliation: Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.|Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Peghin
authors.affiliation: Department of Pulmonology and Lung Transplant Unit, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.|Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Monforte
authors.affiliation: Department of Microbiology, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.
authors.forename: M T
authors.initials: MT
authors.lastname: Martin-Gomez
authors.affiliation: Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.|Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Ruiz-Camps
authors.affiliation: Department of Pulmonology and Lung Transplant Unit, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.|Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Berastegui
authors.affiliation: Department of Pulmonology and Lung Transplant Unit, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.|Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Saez
authors.affiliation: Department of Intensive Care Unit, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Riera
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Solé
authors.affiliation: Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.|Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Gavaldá
authors.affiliation: Department of Pulmonology and Lung Transplant Unit, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.|Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Roman
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001203:Ascomycota / Q000302:isolation & purification; D005260:Female; D005658:Fungi / Q000302:isolation & purification*; D006801:Humans; D000072742:Invasive Fungal Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010407:Penicillium / Q000302:isolation & purification; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D021681:Scedosporium / Q000302:isolation & purification; D060645:Scopulariopsis / Q000302:isolation & purification; D066027:Transplant Recipients; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B
keywords: Purpureocillium; Scedosporium; amphotericin B; emerging fungi; emerging molds; fungal colonization; invasive fungal infections; lung transplant; molds; prophylaxis