Candidemia in solid organ transplant recipients in Spain: Epidemiological trends and determinants of outcome

Background Despite being considered a high‐risk population for invasive fungal disease, specific features of candidemia among solid organ transplant (SOT) recipients remain poorly characterized. Methods We compiled prospective data from two multicenter studies on candidemia performed over two consec...

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Bibliographic Details
Published in:Transplant infectious disease 2019-12, Vol.21 (6), p.e13195-n/a
Main Authors: Fernández‐Ruiz, Mario, Cardozo, Celia, Salavert, Miguel, Aguilar‐Guisado, Manuela, Escolà‐Vergé, Laura, Gioia, Francesca, Montejo, Miguel, Merino, Paloma, Cuervo, Guillermo, García‐Vidal, Carolina, Aguado, José María, Padilla, B, Paño‐Pardo, J. R., García‐Rodríguez, J, García Cerrada, C., Fortún, J, Martín‐Dávila, P., Gómez‐García de la Pedrosa, E, Ryan, P., Campelo, C., de los Santos Gil, I., Buendía, V., Pérez Gorricho, B., Alonso, M., Sanz Sanz, F., González Romo, F., Gorgolas, M., Gadea, I., Delgado‐Iribarren, A., Ramos, A., Sánchez Romero, I., Zaragoza, Ó., Cuenca‐Estrella, M., Rodríguez‐Baño, J., Suárez, A. I., Loza, A., Martín‐Mazuelos, E., Ruiz Pérez de Pipaón, M., Garnacho, J., Ortiz, C, Chávez, M., Maroto, F. L., Pemán, J., Blanquer, J., Navarro, D., Camarena, J. J., Zaragoza, R, Abril, V., Gimeno, C., Hernández, S., Ezpeleta, G., Bereciartua, E., Hernández Almaraz, J. L., Rivas, R. A., Ayarza, R., Planes, A. M., Ruiz‐Camps, I., Almirante, B., Mensa, J., Almela, M., Gurgui, M., Sánchez‐Reus, F., Martínez‐Montauti, J., Sierra, M., Horcajada, J. P., Sorli, L., Gómez, J., Gené, A., Urrea, M., Valerio, M., Díaz‐Martín, A., Puchades, F., Mularoni, A., Puerta‐Alcalde, P., Morata, L., Rodríguez‐Núñez, O., Guerrero, M. A., Carratalà, J., Sabé, N., Ayats, J., Grau, I., Calabuig, E., Castro, I., Cuéllar, S., Fortún, J., Gómez‐García de la Pedrosa, E., Pérez‐Ayala, A., Losada, I., Suarez, M. I., Martín‐Gómez, M. T., Rodríguez‐Alvarez, R., López‐Soira, L., Vena, A., Bouza, E., Guinea, J., Martín, C.
Format: Article
Language:English
Subjects:
Adult
Aged
Antifungal Agents - pharmacology
Antifungal Agents - therapeutic use
Candida albicans - drug effects
Candida albicans - isolation & purification
Candida glabrata - drug effects
Candida glabrata - isolation & purification
Candidemia
Candidemia - drug therapy
Candidemia - epidemiology
Candidemia - microbiology
Confidence intervals
Drug Resistance, Fungal
Epidemiology
Female
Fluconazole
Fluconazole - pharmacology
Fluconazole - therapeutic use
Fungal diseases
Fungicides
Hospital Mortality
Humans
Kidney transplantation
Male
Medical instruments
Microbial Sensitivity Tests
Middle Aged
Mortality
Multicenter Studies as Topic
Organ Transplantation - adverse effects
outcome
Prospective Studies
Risk analysis
Risk Factors
Sepsis
Septic shock
solid organ transplantation
Spain - epidemiology
Transplant Recipients - statistics & numerical data
Transplantation
Transplants & implants
treatment
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Summary:Background Despite being considered a high‐risk population for invasive fungal disease, specific features of candidemia among solid organ transplant (SOT) recipients remain poorly characterized. Methods We compiled prospective data from two multicenter studies on candidemia performed over two consecutive periods in Spain: the CANDIPOP Study (2010‐2011) and the CANDI‐Bundle Study (2016‐2018). Episodes diagnosed in adult SOT recipients in 10 participating centers were included. Risk factors for clinical failure (all‐cause 7‐day mortality and/or persistent candidemia for ≥72 hours) and 30‐day mortality were investigated by univariate analysis. Results We included 55 episodes of post‐transplant candidemia (32 and 23 of which occurred during the first and second periods). Kidney (38.2%) and liver recipients (30.9%) were the most common populations. Candida albicans accounted for 27.3% of episodes. The proportion of C glabrata increased over time (18.8% vs 30.4% for the first and second periods). There were no differences in the rate of fluconazole non‐susceptible isolates (50.0% vs 60.0%, respectively). Clinical failure and 30‐day mortality occurred in 25.5% and 27.3% of episodes and were associated with the severity of candidemia (Pitt score and severe sepsis/septic shock). Kidney transplantation (unadjusted odds ratio [uOR]: 0.17; 95% confidence interval [CI]: 0.03‐0.85; P‐value = .020), early catheter removal (uOR: 0.15; 95% CI: 0.03‐0.76; P‐value = .013), and appropriate early antifungal therapy (uOR: 0.14; 95% CI: 0.02‐0.89; P‐value = .041) were protective for 30‐day mortality. Conclusions High rates of non‐albicans species and fluconazole non‐susceptibility must be taken into account to optimize therapeutic management and outcomes in SOT recipients with candidemia.
ISSN:1398-2273
1399-3062
DOI:10.1111/tid.13195