title: Invasive fungal infection after heart transplantation: A 7-year, single-center experience.
abstract: BACKGROUND
  Invasive fungal infections (IFIs) are an infrequent but major complication of heart transplantation (HT). We sought to describe the epidemiology at our institution.
  
  
  METHODS
  A prospective cohort study of 159 heart transplant recipients was performed from June 2005 to December 2012. IFIs were defined by European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria.
  
  
  RESULTS
  By univariate analysis, Hispanic ethnicity was associated with IFI (P=.01, odds ratio [OR] 7.0, 95% confidence interval [CI] 1.7-27.9). Subsequently, a multivariate logistic regression was performed adjusting for Hispanic ethnicity, age, and gender. Seventeen IFIs were identified, occurring at a median 110 days post HT (interquartile range: 32-411 days). Five IFIs (29% of IFIs and 3.1% of all HT) occurred during the HT hospitalization, with 13 IFIs during the first year (incidence 8.2%).
  
  
  CONCLUSIONS
  The cumulative incidence was 10.7%. IFIs were associated with pre- and post-HT vancomycin-resistant Enterococcus colonization and/or infection, post-HT renal replacement therapy, anti-thymocyte globulin induction, and antibody-mediated rejection. There were no associations with diabetes mellitus, desensitization, 2R/3R cellular rejection, treatments for rejection, re-operation, neutropenia, or cytomegalovirus infection. IFIs were associated with death (P=.02, OR 3.9, 95% CI 1.3-12.1) and 1-year mortality (P<.001, OR 9.0, 95% CI 2.3-35.7), but not 3-year mortality. Associations with Hispanic ethnicity must be validated. Optimal strategies for risk reduction and prophylaxis remain undefined.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Ignacio A
authors.identifier: http://orcid.org/0000-0002-6301-0121
authors.initials: IA
authors.lastname: Echenique
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Angarone
authors.affiliation: Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Gordon
authors.affiliation: Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rich
authors.affiliation: Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Allen S
authors.initials: AS
authors.lastname: Anderson
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Edwin C
authors.initials: EC
authors.lastname: McGee
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Travis O
authors.initials: TO
authors.lastname: Abicht
authors.affiliation: Division of Biostatistics, Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kang
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Division of Organ Transplantation, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Valentina
authors.initials: V
authors.lastname: Stosor
mesh_terms: D000961:Antilymphocyte Serum / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000150:complications* / Q000276:immunology; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000382:microbiology; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D000072742:Invasive Fungal Infections / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D065507:Vancomycin-Resistant Enterococci / Q000302:isolation & purification*
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents
keywords: Aspergillosis; candidiasis; heart transplantation; invasive fungal infection