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)

• Published in: Transplant infectious disease Vol. 18; no. 6; pp. 921 - 931
• Main Authors: Andes, David R., Safdar, Nasia, Baddley, John W., Alexander, Barbara, Brumble, Lisa, Freifeld, Allison, Hadley, Susan, Herwaldt, Loreen, Kauffman, Carol, Lyon, G. Marshall, Morrison, Vicki, Patterson, Thomas, Perl, Trish, Walker, Randall, Hess, Tim, Chiller, Tom, Pappas, Peter G.
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.12.2016; Wiley Subscription Services, Inc
• Subjects: Adult; Allografts - microbiology; Antibiotic Prophylaxis - adverse effects; Antifungal Agents - adverse effects; Antifungal Agents - therapeutic use; Candida; Candida - isolation & purification; Candidiasis, Invasive - epidemiology; Candidiasis, Invasive - microbiology; Candidiasis, Invasive - mortality; Epidemiological Monitoring; Female; Humans; Male; Middle Aged; Organ Transplantation - adverse effects; Organ Transplantation - mortality; Prospective Studies; solid organ transplant; Survival Analysis; Transplant Recipients; United States - epidemiology; Candida; solid organ transplant
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12613

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.