1. Candidemia in solid organ transplant recipients in Spain: Epidemiological trends and determinants of outcome
- Author
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Fernandez-Ruiz, M., Cardozo, C., Salavert, M., Aguilar-Guisado, M., Escola-Verge, L., Munoz, P., Gioia, F., Montejo, M., Merino, P., Cuervo, G., Garcia-Vidal, C., Aguado, J. M., Padilla, B., Guinea, J., Pano-Pardo, J. R., Garcia-Rodriguez, J., Garcia Cerrada, C., Fortun, J., Martin-Davila, P., Gomez-Garcia de la Pedrosa, E., Ryan, P., Campelo, C., de los Santos Gil, I., Buendia, V., Perez Gorricho, B., Alonso, M., Sanz Sanz, F., Gonzalez Romo, F., Gorgolas, M., Gadea, I., Delgado-Iribarren, A., Ramos, A., Romero, Y., Sanchez Romero, I., Zaragoza, O., Cuenca-Estrella, M., Rodriguez-Bano, J., Suarez, A. I., Loza, A., Aller Garcia, A. I., Martin-Mazuelos, E., Ruiz Perez de Pipaon, M., Garnacho, J., Ortiz, C., Chavez, M., Maroto, F. L., Peman, J., Blanquer, J., Navarro, D., Camarena, J. J., Zaragoza, R., Abril, V., Gimeno, C., Hernandez, S., Ezpeleta, G., Bereciartua, E., Hernandez Almaraz, J. L., Rivas, R. A., Ayarza, R., Planes, A. M., Ruiz-Camps, I., Almirante, B., Mensa, J., Almela, M., Gurgui, M., Sanchez-Reus, F., Martinez-Montauti, J., Sierra, M., Horcajada, J. P., Sorli, L., Gomez, J., Gene, A., Urrea, M., Valerio, M., Diaz-Martin, A., Puchades, F., Mularoni, A., Puerta-Alcalde, P., Morata, L., Rodriguez-Nunez, O., Guerrero, M. A., Carratala, J., Sabe, N., Ayats, J., Grau, I., Calabuig, E., Castro, I., Cuellar, S., Perez-Ayala, A., Losada, I., Suarez, M. I., Martin-Gomez, M. T., Rodriguez-Alvarez, R., Lopez-Soira, L., Vena, A., Bouza, E., Martin, C., Gilead Sciences, Astellas Pharma, Pfizer, Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica, Fundación SEIMC-GESIDA, Ministerio de Ciencia, Innovación y Universidades (España), Red Española de Investigación en Patología Infecciosa, and Instituto de Salud Carlos III
- Subjects
Male ,Antifungal Agents ,Epidemiology ,candidemia ,epidemiology ,outcome ,solid organ transplantation ,treatment ,Adult ,Aged ,Candida albicans ,Candida glabrata ,Candidemia ,Drug Resistance, Fungal ,Female ,Fluconazole ,Hospital Mortality ,Humans ,Microbial Sensitivity Tests ,Middle Aged ,Multicenter Studies as Topic ,Organ Transplantation ,Prospective Studies ,Risk Factors ,Spain ,Transplant Recipients ,Drug Resistance ,Solid organ transplantation ,Kidney transplantation ,Outcome ,education.field_of_study ,Univariate analysis ,Infectious Diseases ,Fungal ,medicine.drug ,medicine.medical_specialty ,Population ,Internal medicine ,medicine ,education ,Transplantation ,business.industry ,Septic shock ,Odds ratio ,medicine.disease ,Confidence interval ,Treatment ,business - Abstract
CANDIPOP Project, the CANDI‐Bundle Group GEIRAS‐GEMICOMED (SEIMC) REIPI., [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., The CANDIPOP Project was supported by non‐restrictive research grants from Gilead Sciences, MSD, Astellas Pharma, and Pfizer. This study was cofounded by Fundación SEIMC‐GESIDA, by the Spanish Ministry of Science, Innovation and Universities, Instituto de Salud Carlos III (co‐financed by the European Development Regional Fund [ERDF] >A way to achieve Europe>), and by the Spanish Network for Research in Infectious Diseases (REIPI RD12/0015). The CANDI‐Bundle Study was supported by “Plan Nacional de I + D+I” and Instituto de Salud Carlos III (Fondo de Investigaciones Sanitarias [FIS] PI15/00744), Subdirección General de Redes y Centros de Investigación Cooperativa, Spanish Ministry of Science, Innovation and Universities, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016). MFR holds a research contract “Miguel Servet” (CP 18/00073) from the Spanish Ministry of Science, Innovation and Universities, Instituto de Salud Carlos III.
- Published
- 2019