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Background : Invasive fungal infection (IFI) remains a common complication after lung transplantation, causing significant morbidity and mortality. We have attempted to quantify systematically risk factors of IFI in lung transplant recipients. Methods : Studies were retrieved from Ovid MEDLINE, Ovid Embase, Cochrane database of systematic reviews and Cochrane central register of controlled trials. All case-control and cohort studies evaluating the risk factors of IFI in adult lung transplant recipients were screened. Two researchers reviewed and assessed all studies independently. We pooled the estimated effect of each factor associated with IFI by using a random effect model. Results : Eight studies were included in the systematic review and five studies were eligible for the meta-analysis. Rates of IFI range from 8-33% in lung transplant recipients. Independent risk factors for invasive aspergillosis (IA) in lung transplantation include previous fungal colonization (OR 2.44; 95% CI 0.08-0.47), cytomegalovirus infection (OR 1.96; 95% CI 1.08-3.56) and single lung transplantation (OR 1.77; 95% CI 1.08-2.91). Pre-emptive antifungal therapy (OR 0.20; 95% CI 0.09-0.48) is a protective factor for IA in lung transplant (OR 0.2; 95% CI 0.08-0.47). Conclusion : Cytomegalovirus infection, previous fungal colonization and single lung transplantation independently increase the risk of IA in lung transplant recipients. Pre-emptive antifungal therapy is a protective factor for IA in the lung transplant population.

Background: Mycobacterium mucogenicum and Mycobacterium neoaurum are infrequent causes of bacteremia in humans. When they are isolated from blood, it is not unusual for them to initially be considered contaminants. Methods: A retrospective chart review of patients diagnosed with M. mucogenicum and M. neoaurum bacteremia from January 1998 to December 2018 was conducted at the University Health Network, Toronto, Ontario, Canada. Results: We identified 28 patients who had bacteremia caused by these organisms. These patients were primarily immunocompromised, had chronically indwelling vascular access devices, or used intravenous drugs. For 29% of the patients, the isolation of these mycobacteria was considered colonization, whereas 82% of the patients received antimicrobial therapy and 95% had the central line removed. Conclusions: The removal of the vascular access device and treatment with either single or combination antimicrobial therapy produced successful outcomes for people with these infections.

Background Statins are competitive inhibitors of 3-hydroxy-3methylglutaryl coenzyme A reductase (HMG-CoA reductase) that catalyses HMG-CoA conversion to mevalonate, a process involved in synthesizing cholesterol in humans and ergosterol in fungi. The effect of statin use on the risk of development of invasive aspergillosis (IA) in lung transplant recipients (LTRs) is not well documented. Methods This retrospective study included LTRs from 2010 to 2017 who were followed for one-year post-transplant. Proven or probable IA was diagnosed as per ISHLT criteria. We performed a multivariable Cox proportional hazards model of the association between IA and statin use (minimum of 2 weeks duration prior to IA), adjusting for other known IA risk factors. Results We identified 785 LTRs, 44% female, mean age 53 years old, the most common underlying disease being pulmonary fibrosis (23.8%). In total, 451 LTRs (57%) received statins post-transplant, atorvastatin was the most commonly used statin (68%). The mean duration of statins post-transplant was 347 days (interquartile range [IQR]: 305 to 346). And 55 (7%) LTRs developed IA in the first-year post-transplant. Out of these 55 LTRs, 9 (16.3%) had received statin before developing IA. In multivariable analysis, statin use was independently associated with a lower risk of IA (P = .002, SHR 0.30, 95% confidence interval [CI] 95% .14–.64). Statin use was also associated with a lower incidence of post-transplant Aspergillus colonization, 114 (34%) in the no statin group vs 123 (27%) in the statin group (P = .038). Conclusions The use of statin for a minimum of two weeks during the first-year post-transplant was associated with a 70% risk reduction of IA in LTRs.

Invasive fungal infections (IFIs) remain one of the most common infectious complications after organ transplantation, and liver transplant recipients (LTRs) have the highest mortality rate. However, risk factors associated with IFIs have only been evaluated in small single-center studies. We performed a meta-analysis by conducting a comprehensive search using Ovid MEDLINE, Ovid Embase, Cochrane database of systematic reviews, and Cochrane central register of controlled trials. All case-control and cohort studies evaluating risk factors for IFIs in adult LTRs were screened. Utilizing a random-effects model, a multivariate analysis was completed, and 28 studies were eligible for meta-analysis. Rates of IFIs ranged from 1.4% to 32.7%. Previous antibiotic use (OR 9.3; 95% CI 3.2-27.0) and bacterial infection (OR 4.3; 95% CI 2.1-8.6) were risk factors of invasive candidiasis. Yet for invasive aspergillosis, posttransplant renal replacement therapy (OR 9.2; 95% CI 4.2-20.4), reoperation (OR 8.0; 95% CI 2.9-21.7), and cytomegalovirus infection (OR 6.2; 95% CI 2.0-19.3) were risk factors. The top independent risk factors for IFIs during studies from 2010 to 2019 were previous fungal colonization (OR 9.19; 95% CI 4.92-17.16), reoperation (OR 5.45; 95% CI 2.93-10.15), and previous bacterial infections (OR 3.81; 95% CI 2.13-6.83). These risk factors may be targeted by antifungal prophylaxis in LTRs.

Background Mycobacterium mucogenicum and Mycobacterium neoaurum are an infrequent cause of bloodstream infection in humans. When they are isolated from blood, it is not unusual for them to be considered to be contaminants initially. Methods A retrospective chart review of patients diagnosed with M. mucogenicum and M. neoaurum bacteremia was conducted from January 1998 to December 2018 at the University Health Network, Toronto, Canada. Results We identified 28 patients who had bloodstream infection caused by these organisms. These patients were immunocompromised hosts, patients with chronically indwelling vascular access devices or injection drug users. In 28.5% of the patients the isolation of these mycobacteria was considered colonization, 82% of the cases received antimicrobial therapy and in 95% of the patients the central line was removed. Conclusions The removal of the vascular access device and treatment with either single or combination antimicrobial therapy produced successful outcomes for these infections.

Lung transplantation has emerged as a lifesaving treatment for a wide range of advanced lung diseases. While the survival of lung transplant recipients continues to improve, infectious complications contribute substantially to morbidity and mortality following lung transplantation. The incidence of invasive fungal infections is variable, with a mean occurrence of 8.6%. The majority of fungal infections in lung transplant recipients are caused Aspergillus and Candida species. This review provides an update in the current approaches for the diagnosis, management and prevention of fungal infections and the late complications that are associated.