Incidence and outcome of fungal infections in pediatric small bowel transplant recipients

Diana F Florescu, K. M. Islam, W. Grant, David F Mercer, Alan Norman Langnas, J. Botha, B. Nielsen, Andre C Kalil

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Data on the incidence, timing, and outcome of fungal infections in pediatric small bowel transplantation (SBT) are lacking.Methods. Cases of pediatric SBT from January 2003 through December 2007 were collected. Standard induction was with thymoglobulin and/or basiliximab and maintenance immunosuppression was a tacrolimus-based regimen. Chi-square was used for categorical variables and Kaplan-Meier for survival analyses. Results: A total 98 recipients were included; 25 patients developed 59 episodes of Candida infections and 4 episodes of invasive aspergillosis (incidence 25.5%, 95% confidence interval [CI] 17%, 34%). Of the Candida species, 37.3% were Candida albicans and 62.7% non-albicans Candida. Of all yeast infections, 66.1% were fungemia, 28.8% intra-abdominal infections, 1.7% empyema, and 3.4% urinary tract infection. Of the Candida intra-abdominal infections, 41.2% developed in the first month post transplantation, while 79.5% of candidemia developed after >6 months. Median time from transplantation to fungal infection was significantly shorter for abdominal infections compared with fungemia (9 versus 163 days; P=0.004). All-cause mortality was not significantly different between patients with and without fungal infections (32.3% versus 29.8%; odds ratio=1.12, 95% CI 0.45, 2.8).Conclusion. Fungal infections occurred in 25% of SBT recipients and C. albicans was the most common species. Intra-abdominal fungal infections occurred earlier (<1 month) than fungemia (>6 months) post transplantation.

Original languageEnglish (US)
Pages (from-to)497-504
Number of pages8
JournalTransplant Infectious Disease
Volume12
Issue number6
DOIs
StatePublished - Dec 1 2010

Fingerprint

Mycoses
Transplantation
Pediatrics
Intraabdominal Infections
Candida
Incidence
Fungemia
Candida albicans
Infection
Confidence Intervals
Candidemia
Empyema
Aspergillosis
Kaplan-Meier Estimate
Tacrolimus
Survival Analysis
Urinary Tract Infections
Immunosuppression
Transplant Recipients
Yeasts

Keywords

  • Aspergillus
  • Candida
  • Fungal infections
  • Pediatric transplant
  • Small bowel transplantation

ASJC Scopus subject areas

  • Infectious Diseases
  • Transplantation

Cite this

Incidence and outcome of fungal infections in pediatric small bowel transplant recipients. / Florescu, Diana F; Islam, K. M.; Grant, W.; Mercer, David F; Langnas, Alan Norman; Botha, J.; Nielsen, B.; Kalil, Andre C.

In: Transplant Infectious Disease, Vol. 12, No. 6, 01.12.2010, p. 497-504.

Research output: Contribution to journalArticle

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abstract = "Background: Data on the incidence, timing, and outcome of fungal infections in pediatric small bowel transplantation (SBT) are lacking.Methods. Cases of pediatric SBT from January 2003 through December 2007 were collected. Standard induction was with thymoglobulin and/or basiliximab and maintenance immunosuppression was a tacrolimus-based regimen. Chi-square was used for categorical variables and Kaplan-Meier for survival analyses. Results: A total 98 recipients were included; 25 patients developed 59 episodes of Candida infections and 4 episodes of invasive aspergillosis (incidence 25.5{\%}, 95{\%} confidence interval [CI] 17{\%}, 34{\%}). Of the Candida species, 37.3{\%} were Candida albicans and 62.7{\%} non-albicans Candida. Of all yeast infections, 66.1{\%} were fungemia, 28.8{\%} intra-abdominal infections, 1.7{\%} empyema, and 3.4{\%} urinary tract infection. Of the Candida intra-abdominal infections, 41.2{\%} developed in the first month post transplantation, while 79.5{\%} of candidemia developed after >6 months. Median time from transplantation to fungal infection was significantly shorter for abdominal infections compared with fungemia (9 versus 163 days; P=0.004). All-cause mortality was not significantly different between patients with and without fungal infections (32.3{\%} versus 29.8{\%}; odds ratio=1.12, 95{\%} CI 0.45, 2.8).Conclusion. Fungal infections occurred in 25{\%} of SBT recipients and C. albicans was the most common species. Intra-abdominal fungal infections occurred earlier (<1 month) than fungemia (>6 months) post transplantation.",
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