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Breakthrough invasive fungal infection after liver transplantation in patients on targeted antifungal prophylaxis: A prospective multicentre study

OBJECTIVE: To investigate the rate of and the risk factors for breakthrough‐IFI (b‐IFI) after orthotopic liver transplantation (OLT) according to the new definition proposed by Mycoses‐Study‐Group‐Education‐and‐Research‐Consortium (MSG‐ERC) and the European‐Confederation‐of‐Medical‐Mycology (ECMM)....

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Autores principales: Rinaldi, Matteo, Bartoletti, Michele, Ferrarese, Alberto, Franceschini, Erica, Campoli, Caterina, Coladonato, Simona, Pascale, Renato, Tedeschi, Sara, Gatti, Milo, Cricca, Monica, Ambretti, Simone, Siniscalchi, Antonio, Morelli, Maria Cristina, Cescon, Matteo, Cillo, Umberto, Di Benedetto, Fabrizio, Burra, Patrizia, Mussini, Cristina, Cristini, Francesco, Lewis, Russell, Viale, Pierluigi, Giannella, Maddalena
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8519035/
https://www.ncbi.nlm.nih.gov/pubmed/33768656
http://dx.doi.org/10.1111/tid.13608
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author Rinaldi, Matteo
Bartoletti, Michele
Ferrarese, Alberto
Franceschini, Erica
Campoli, Caterina
Coladonato, Simona
Pascale, Renato
Tedeschi, Sara
Gatti, Milo
Cricca, Monica
Ambretti, Simone
Siniscalchi, Antonio
Morelli, Maria Cristina
Cescon, Matteo
Cillo, Umberto
Di Benedetto, Fabrizio
Burra, Patrizia
Mussini, Cristina
Cristini, Francesco
Lewis, Russell
Viale, Pierluigi
Giannella, Maddalena
author_facet Rinaldi, Matteo
Bartoletti, Michele
Ferrarese, Alberto
Franceschini, Erica
Campoli, Caterina
Coladonato, Simona
Pascale, Renato
Tedeschi, Sara
Gatti, Milo
Cricca, Monica
Ambretti, Simone
Siniscalchi, Antonio
Morelli, Maria Cristina
Cescon, Matteo
Cillo, Umberto
Di Benedetto, Fabrizio
Burra, Patrizia
Mussini, Cristina
Cristini, Francesco
Lewis, Russell
Viale, Pierluigi
Giannella, Maddalena
author_sort Rinaldi, Matteo
collection PubMed
description OBJECTIVE: To investigate the rate of and the risk factors for breakthrough‐IFI (b‐IFI) after orthotopic liver transplantation (OLT) according to the new definition proposed by Mycoses‐Study‐Group‐Education‐and‐Research‐Consortium (MSG‐ERC) and the European‐Confederation‐of‐Medical‐Mycology (ECMM). METHODS: Multicenter prospective study of adult patients who underwent OLT at three Italian hospitals, from January 2015 to December 2018. Targeted antifungal prophylaxis (TAP) protocol was developed and shared among participating centers. Follow‐up was 1‐year after OLT. B‐IFI was defined as infection occurring during exposure to antifungal prophylaxis. Risk factors for b‐IFI were analyzed among patients exposed to prophylaxis by univariable analysis. RESULTS: We enrolled 485 OLT patients. Overall compliance to TAP protocol was 64.3%, 220 patients received antifungal prophylaxis, 172 according to TAP protocol. Twenty‐nine patients were diagnosed of IFI within 1 year after OLT. Of them, 11 presented with b‐IFI within 17 (IQR 11‐33) and 16 (IQR 4‐30) days from OLT and from antifungal onset, respectively. Then out of 11 patients with b‐IFI were classified as having high risk of IFI and were receiving anti‐mould prophylaxis, nine with echinocandins and one with polyenes. Comparison of patients with and without b‐IFI showed significant differences for prior Candida colonization, need of renal replacement therapy after OLT, re‐operation, and CMV infection (whole blood CMV‐DNA >100 000 copies/mL). Although non‐significant, a higher rate of b‐IFI in patients on echinocandins was observed (8.2% vs 1.8%, P = .06). CONCLUSIONS: We observed 5% of b‐IFI among OLT patients exposed to antifungal prophylaxis. The impact of echinocandins on b‐IFI risk in this setting should be further explored.
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spelling pubmed-85190352021-10-21 Breakthrough invasive fungal infection after liver transplantation in patients on targeted antifungal prophylaxis: A prospective multicentre study Rinaldi, Matteo Bartoletti, Michele Ferrarese, Alberto Franceschini, Erica Campoli, Caterina Coladonato, Simona Pascale, Renato Tedeschi, Sara Gatti, Milo Cricca, Monica Ambretti, Simone Siniscalchi, Antonio Morelli, Maria Cristina Cescon, Matteo Cillo, Umberto Di Benedetto, Fabrizio Burra, Patrizia Mussini, Cristina Cristini, Francesco Lewis, Russell Viale, Pierluigi Giannella, Maddalena Transpl Infect Dis Original Articles OBJECTIVE: To investigate the rate of and the risk factors for breakthrough‐IFI (b‐IFI) after orthotopic liver transplantation (OLT) according to the new definition proposed by Mycoses‐Study‐Group‐Education‐and‐Research‐Consortium (MSG‐ERC) and the European‐Confederation‐of‐Medical‐Mycology (ECMM). METHODS: Multicenter prospective study of adult patients who underwent OLT at three Italian hospitals, from January 2015 to December 2018. Targeted antifungal prophylaxis (TAP) protocol was developed and shared among participating centers. Follow‐up was 1‐year after OLT. B‐IFI was defined as infection occurring during exposure to antifungal prophylaxis. Risk factors for b‐IFI were analyzed among patients exposed to prophylaxis by univariable analysis. RESULTS: We enrolled 485 OLT patients. Overall compliance to TAP protocol was 64.3%, 220 patients received antifungal prophylaxis, 172 according to TAP protocol. Twenty‐nine patients were diagnosed of IFI within 1 year after OLT. Of them, 11 presented with b‐IFI within 17 (IQR 11‐33) and 16 (IQR 4‐30) days from OLT and from antifungal onset, respectively. Then out of 11 patients with b‐IFI were classified as having high risk of IFI and were receiving anti‐mould prophylaxis, nine with echinocandins and one with polyenes. Comparison of patients with and without b‐IFI showed significant differences for prior Candida colonization, need of renal replacement therapy after OLT, re‐operation, and CMV infection (whole blood CMV‐DNA >100 000 copies/mL). Although non‐significant, a higher rate of b‐IFI in patients on echinocandins was observed (8.2% vs 1.8%, P = .06). CONCLUSIONS: We observed 5% of b‐IFI among OLT patients exposed to antifungal prophylaxis. The impact of echinocandins on b‐IFI risk in this setting should be further explored. John Wiley and Sons Inc. 2021-05-03 2021-08 /pmc/articles/PMC8519035/ /pubmed/33768656 http://dx.doi.org/10.1111/tid.13608 Text en © 2021 The Authors. Transplant Infectious Disease published by Wiley Periodicals LLC. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Rinaldi, Matteo
Bartoletti, Michele
Ferrarese, Alberto
Franceschini, Erica
Campoli, Caterina
Coladonato, Simona
Pascale, Renato
Tedeschi, Sara
Gatti, Milo
Cricca, Monica
Ambretti, Simone
Siniscalchi, Antonio
Morelli, Maria Cristina
Cescon, Matteo
Cillo, Umberto
Di Benedetto, Fabrizio
Burra, Patrizia
Mussini, Cristina
Cristini, Francesco
Lewis, Russell
Viale, Pierluigi
Giannella, Maddalena
Breakthrough invasive fungal infection after liver transplantation in patients on targeted antifungal prophylaxis: A prospective multicentre study
title Breakthrough invasive fungal infection after liver transplantation in patients on targeted antifungal prophylaxis: A prospective multicentre study
title_full Breakthrough invasive fungal infection after liver transplantation in patients on targeted antifungal prophylaxis: A prospective multicentre study
title_fullStr Breakthrough invasive fungal infection after liver transplantation in patients on targeted antifungal prophylaxis: A prospective multicentre study
title_full_unstemmed Breakthrough invasive fungal infection after liver transplantation in patients on targeted antifungal prophylaxis: A prospective multicentre study
title_short Breakthrough invasive fungal infection after liver transplantation in patients on targeted antifungal prophylaxis: A prospective multicentre study
title_sort breakthrough invasive fungal infection after liver transplantation in patients on targeted antifungal prophylaxis: a prospective multicentre study
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8519035/
https://www.ncbi.nlm.nih.gov/pubmed/33768656
http://dx.doi.org/10.1111/tid.13608
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