1. Zygomycosis in Solid Organ Transplant Recipients: A Prospective, Matched Case‐Control Study to Assess Risks for Disease and Outcome
- Author
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Pilar Martín-Dávila, Marino Blanes Julia, François Philit, Erik R. Dubberke, Cornelia Lass-Flörl, Nina Singh, Robin Patel, Kenneth Pursell, Emily A. Blumberg, Valérie Chatelet, Nasia Safdar, Shimon Kusne, Abhi Humar, Graeme N. Forrest, Nicolas Terzi, Jesús Fortún, Nina M. Clark, Michelle A. Barron, Sally Houston, Krishan Lal Gupta, Bruno Philippe, Alexis Tabah, Patricia Muñoz, Hugo Bonatti, Leonard B. Johnson, George John, Olivier Lortholary, and Jose M. Aguado
- Subjects
Male ,medicine.medical_specialty ,Antifungal Agents ,Lower risk ,Immunocompromised Host ,Postoperative Complications ,Zygomycosis ,Risk Factors ,Internal medicine ,Humans ,Immunology and Allergy ,Medicine ,Disseminated disease ,Prospective Studies ,Prospective cohort study ,Aged ,Voriconazole ,business.industry ,Organ Transplantation ,Odds ratio ,Middle Aged ,medicine.disease ,Tacrolimus ,Surgery ,Transplantation ,Infectious Diseases ,Case-Control Studies ,Female ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
BACKGROUND Clinical characteristics, risks, and outcomes in solid organ transplant (SOT) recipients with zygomycosis in the era of modern immunosuppressive and newer antifungal agent use have not been defined. METHODS In a matched case-controlled study, SOT recipients with zygomycosis were prospectively studied. The primary outcome measure was success (complete or partial response) at 90 days. RESULTS Renal failure (odds ratio [OR], 3.17; P = .010), diabetes mellitus (OR, 8.11; P < .001), and prior voriconazole and/or caspofungin use (OR, 4.41; P = .033) were associated with a higher risk of zygomycosis, whereas tacrolimus (OR, 0.23; P = .002) was associated with a lower risk of zygomycosis. Liver transplant recipients were more likely to have disseminated disease (OR, 5.48; P = .021) and developed zygomycosis earlier after transplantation than did other SOT recipients (median, 0.8 vs 5.7 months; P < .001). Overall the treatment success rate was 60%. Renal failure (OR, 11.3; P = .023) and disseminated disease (OR, 14.6; P = .027) were independently predictive of treatment failure, whereas surgical resection was associated with treatment success (OR, 33.3; P = .003). The success rate with liposomal amphotericin B was 4-fold higher even when controlling for the aforementioned variables. CONCLUSIONS The risks identified for zygomycosis and for disseminated disease, including those that were previously unrecognized, have implications for further elucidating the biologic basis and for optimizing outcomes in SOT recipients with zygomycosis.
- Published
- 2009
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