title: The epidemiology and outcomes of invasive Candida infections among organ transplant recipients in the United States: results of the Transplant-Associated Infection Surveillance Network (TRANSNET).
abstract: BACKGROUND
  Invasive candidiasis (IC) is a common cause of mortality in solid organ transplant recipients (OTRs), but knowledge of epidemiology in this population is limited.
  
  
  METHODS
  The present analysis describes data from 15 US centers that prospectively identified IC from nearly 17 000 OTRs. Analyses were undertaken to determine predictors of infection and mortality.
  
  
  RESULTS
  A total of 639 cases of IC were identified. The most common species was Candida albicans (46.3%), followed by Candida glabrata (24.4%) and Candida parapsilosis (8.1%). In 68 cases >1 species was identified. The most common infection site was bloodstream (44%), followed by intra-abdominal (14%). The most frequently affected allograft groups were liver (41.1%) and kidney (35.3%). All-cause mortality at 90 days was 26.5% for all species and was highest for Candida tropicalis (44%) and C. parapsilosis (35.2%). Non-white race and female gender were more commonly associated with non-albicans species. A high rate of breakthrough IC was seen in patients receiving antifungal prophylaxis (39%). Factors associated with mortality include organ dysfunction, lung transplant, and treatment with a polyene antifungal. The only modifiable factor identified was choice of antifungal drug class based upon infecting Candida species.
  
  
  CONCLUSIONS
  These data highlight the common and distinct features of IC in OTRs.
authors.affiliation: Department of Medicine and Microbiology, University of Wisconsin, Madison, WI, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Andes
authors.affiliation: Department of Medicine and Microbiology, University of Wisconsin, Madison, WI, USA.
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Baddley
authors.affiliation: Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Alexander
authors.affiliation: Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Brumble
authors.affiliation: Department of Medicine, University of Nebraska, Lincoln, NE, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Freifeld
authors.affiliation: Department of Medicine, Tufts University, Boston, MA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Hadley
authors.affiliation: Department of Medicine, University of Iowa School of Medicine, Iowa City, IA, USA.
authors.forename: Loreen
authors.initials: L
authors.lastname: Herwaldt
authors.affiliation: Department of Medicine, Michigan University School of Medicine, Ann Arbor, MI, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Kauffman
authors.affiliation: Emory University, Atlanta, GA, USA.
authors.forename: G Marshall
authors.initials: GM
authors.lastname: Lyon
authors.affiliation: Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
authors.forename: Vicki
authors.initials: V
authors.lastname: Morrison
authors.affiliation: Department of Medicine, University of Texas at San Antonio, San Antonio, TX, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Patterson
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Trish
authors.initials: T
authors.lastname: Perl
authors.affiliation: Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Randall
authors.initials: R
authors.lastname: Walker
authors.affiliation: Department of Medicine and Microbiology, University of Wisconsin, Madison, WI, USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Hess
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Tom
authors.initials: T
authors.lastname: Chiller
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Pappas
mesh_terms: D000328:Adult; D064591:Allografts / Q000382:microbiology*; D019072:Antibiotic Prophylaxis / Q000009:adverse effects*; D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification*; D058365:Candidiasis, Invasive / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects* / Q000401:mortality; D011446:Prospective Studies; D016019:Survival Analysis; D066027:Transplant Recipients; D014481:United States / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents
keywords: 
  Candida
  ; solid organ transplant