Antifungal prophylaxis in pediatric lung transplantation: An international multicenter survey

2014 ◽  
Vol 18 (4) ◽  
pp. 393-397 ◽  
Author(s):  
Lee Mead ◽  
Lara A. Danziger-Isakov ◽  
Marian G. Michaels ◽  
Samuel Goldfarb ◽  
Allan R. Glanville ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Antifungal Prophylaxis ◽  
Multicenter Survey ◽  
International Multicenter

scholarly journals Isavuconazole Is as Effective as and Better Tolerated Than Voriconazole for Antifungal Prophylaxis in Lung Transplant Recipients

2020 ◽  
Author(s):  
Palash Samanta ◽  
Cornelius J Clancy ◽  
Rachel V Marini ◽  
Ryan M Rivosecchi ◽  
Erin K McCreary ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Transplantation ◽  
Lung Transplant ◽  
Fungal Infections ◽  
Oral Intake ◽  
Antifungal Prophylaxis ◽  
Red Blood Cell Transfusion ◽  
Transplant Recipients ◽  
Independent Risk Factors ◽  
Lung Transplant Recipients

Abstract Background Invasive fungal infections (IFIs) are common following lung transplantation. Isavuconazole is unstudied as prophylaxis in organ transplant recipients. We compared effectiveness and tolerability of isavuconazole and voriconazole prophylaxis in lung transplant recipients. Methods A single-center, retrospective study of patients who received isavuconazole (September 2015–February 2018) or voriconazole (September 2013–September 2015) for antifungal prophylaxis. IFIs were defined by EORTC/MSG criteria. Results Patients received isavuconazole (n = 144) or voriconazole (n = 156) for median 3.4 and 3.1 months, respectively. Adjunctive inhaled amphotericin B (iAmB) was administered to 100% and 41% of patients in the respective groups. At 1 year, 8% of patients receiving isavuconazole or voriconazole developed IFIs. For both groups, 70% and 30% of IFIs were caused by molds and yeasts, respectively, and breakthrough IFI (bIFI) rate was 3%. Outcomes did not significantly differ for patients receiving or not receiving iAmB. Independent risk factors for bIFI and breakthrough invasive mold infection (bIMI) were mold-positive respiratory culture and red blood cell transfusion >7 units at transplant. Bronchial necrosis >2 cm from anastomosis and basiliximab induction were also independent risk factors for bIMI. Isavuconazole and voriconazole were discontinued prematurely due to adverse events in 11% and 36% of patients, respectively (P = .0001). Most common causes of voriconazole and isavuconazole discontinuation were hepatotoxicity and lack of oral intake, respectively. Patients receiving ≥90 days prophylaxis had fewer IFIs at 1 year (3% vs 9%, P = .02). IFIs were associated with increased mortality (P = .0001) and longer hospitalizations (P = .0005). Conclusions Isavuconazole was effective and well tolerated as antifungal prophylaxis following lung transplantation.

scholarly journals Invasive Fungal Infection After Lung Transplantation: Epidemiology in the Setting of Antifungal Prophylaxis

2019 ◽  
Vol 70 (1) ◽  
pp. 30-39 ◽  
Author(s):  
Arthur W Baker ◽  
Eileen K Maziarz ◽  
Christopher J Arnold ◽  
Melissa D Johnson ◽  
Adrienne D Workman ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Amphotericin B ◽  
Prevalence Rate ◽  
Lung Transplant ◽  
Tertiary Care ◽  
Antifungal Prophylaxis ◽  
Transplant Recipients ◽  
Lipid Complex ◽  
Amphotericin B Lipid Complex ◽  
Lung Transplant Recipients

Abstract Background Lung transplant recipients commonly develop invasive fungal infections (IFIs), but the most effective strategies to prevent IFIs following lung transplantation are not known. Methods We prospectively collected clinical data on all patients who underwent lung transplantation at a tertiary care academic hospital from January 2007–October 2014. Standard antifungal prophylaxis consisted of aerosolized amphotericin B lipid complex during the transplant hospitalization. For the first 180 days after transplant, we analyzed prevalence rates and timing of IFIs, risk factors for IFIs, and data from IFIs that broke through prophylaxis. Results In total, 156 of 815 lung transplant recipients developed IFIs (prevalence rate, 19.1 IFIs per 100 surgeries, 95% confidence interval [CI] 16.4–21.8%). The prevalence rate of invasive candidiasis (IC) was 11.4% (95% CI 9.2–13.6%), and the rate of non-Candida IFIs was 8.8% (95% CI 6.9–10.8%). First episodes of IC occurred a median of 31 days (interquartile range [IQR] 16–56 days) after transplant, while non-Candida IFIs occurred later, at a median of 86 days (IQR 40–121 days) after transplant. Of 169 IFI episodes, 121 (72%) occurred in the absence of recent antifungal prophylaxis; however, IC and non-Candida breakthrough IFIs were observed, most often representing failures of micafungin (n = 16) and aerosolized amphotericin B (n = 24) prophylaxis, respectively. Conclusions Lung transplant recipients at our hospital had high rates of IFIs, despite receiving prophylaxis with aerosolized amphotericin B lipid complex during the transplant hospitalization. These data suggest benefit in providing systemic antifungal prophylaxis targeting Candida for up to 90 days after transplant and extending mold-active prophylaxis for up to 180 days after surgery.

scholarly journals IS UNIVERSAL ANTIFUNGAL PROPHYLAXIS MANDATORY IN ADULTS AFTER LUNG TRANSPLANTATION? A METAANALYSIS OF OBSERVATIONAL STUDIES

2015 ◽  
Vol 3 (Suppl 1) ◽  
pp. A1020
Author(s):  
K Pilarczyk ◽  
J Heckmann ◽  
H Carstens ◽  
C Draese ◽  
H Jakob ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Observational Studies ◽  
Antifungal Prophylaxis

International Multicenter Survey of Perioperative Management of External Ventricular Drains

2020 ◽  
Vol 32 (2) ◽  
pp. 132-139 ◽  
Author(s):  
Abhijit V. Lele ◽  
Brianna Mills ◽  
Qian Qiu ◽  
Nina Schloemerkemper ◽  
Bhiken Ishwarlal Naik ◽  
...  
Keyword(s):  
Perioperative Management ◽  
Multicenter Survey ◽  
International Multicenter

Antifungal Prophylaxis During the Early Postoperative Period of Lung Transplantation

CHEST Journal ◽  
1999 ◽  
Vol 115 (5) ◽  
pp. 1301-1304 ◽  
Author(s):  
Viéctor Calvo ◽  
Joseé M. Borro ◽  
Pilar Morales ◽  
Alfonso Morcillo ◽  
Rosario Vicente ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Postoperative Period ◽  
Antifungal Prophylaxis ◽  
Early Postoperative Period
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