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Transpl Infect Dis. 2016 Dec;18(6):921-931. doi: 10.1111/tid.12613. Epub 2016 Nov 14.

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).

Author information

1
Department of Medicine and Microbiology, University of Wisconsin, Madison, WI, USA.
2
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
3
Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
4
Department of Medicine, Mayo Clinic, Rochester, MN, USA.
5
Department of Medicine, University of Nebraska, Lincoln, NE, USA.
6
Department of Medicine, Tufts University, Boston, MA, USA.
7
Department of Medicine, University of Iowa School of Medicine, Iowa City, IA, USA.
8
Department of Medicine, Michigan University School of Medicine, Ann Arbor, MI, USA.
9
Emory University, Atlanta, GA, USA.
10
Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
11
Department of Medicine, University of Texas at San Antonio, San Antonio, TX, USA.
12
Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
13
Centers for Disease Control and Prevention, Atlanta, GA, USA.

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.

METHOD:

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.

CONCLUSION:

These data highlight the common and distinct features of IC in OTRs.

KEYWORDS:

Candida ; solid organ transplant

PMID:
27643395
DOI:
10.1111/tid.12613
[Indexed for MEDLINE]

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