The epidemiology and outcomes of invasive Candida infections among organ transplant recipients in the United States: results of the Transplant-Associated Infection Surveillance Network (TRANSNET)

The TRANSNET Investigators

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45 Citations (Scopus)

Abstract

Background: Invasive candidiasis (IC) is a common cause of mortality in solid organ transplant recipients (OTRs), but knowledge of epidemiology in this population is limited. Method: The present analysis describes data from 15 US centers that prospectively identified IC from nearly 17 000 OTRs. Analyses were undertaken to determine predictors of infection and mortality. Results: A total of 639 cases of IC were identified. The most common species was Candida albicans (46.3%), followed by Candida glabrata (24.4%) and Candida parapsilosis (8.1%). In 68 cases >1 species was identified. The most common infection site was bloodstream (44%), followed by intra-abdominal (14%). The most frequently affected allograft groups were liver (41.1%) and kidney (35.3%). All-cause mortality at 90 days was 26.5% for all species and was highest for Candida tropicalis (44%) and C. parapsilosis (35.2%). Non-white race and female gender were more commonly associated with non-albicans species. A high rate of breakthrough IC was seen in patients receiving antifungal prophylaxis (39%). Factors associated with mortality include organ dysfunction, lung transplant, and treatment with a polyene antifungal. The only modifiable factor identified was choice of antifungal drug class based upon infecting Candida species. Conclusion: These data highlight the common and distinct features of IC in OTRs.

Original languageEnglish (US)
Pages (from-to)921-931
Number of pages11
JournalTransplant Infectious Disease
Volume18
Issue number6
DOIs
StatePublished - Dec 1 2016

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Invasive Candidiasis
Candida
Epidemiology
Transplants
Infection
Mortality
Candida tropicalis
Candida glabrata
Polyenes
Candida albicans
Allografts
Transplant Recipients
Kidney
Lung
Liver
Pharmaceutical Preparations
Population

Keywords

  • Candida
  • solid organ transplant

ASJC Scopus subject areas

  • Infectious Diseases
  • Transplantation

Cite this

@article{b48cf8a7e7504f9cac72f3a46ec2b956,
title = "The epidemiology and outcomes of invasive Candida infections among organ transplant recipients in the United States: results of the Transplant-Associated Infection Surveillance Network (TRANSNET)",
abstract = "Background: Invasive candidiasis (IC) is a common cause of mortality in solid organ transplant recipients (OTRs), but knowledge of epidemiology in this population is limited. Method: The present analysis describes data from 15 US centers that prospectively identified IC from nearly 17 000 OTRs. Analyses were undertaken to determine predictors of infection and mortality. Results: A total of 639 cases of IC were identified. The most common species was Candida albicans (46.3{\%}), followed by Candida glabrata (24.4{\%}) and Candida parapsilosis (8.1{\%}). In 68 cases >1 species was identified. The most common infection site was bloodstream (44{\%}), followed by intra-abdominal (14{\%}). The most frequently affected allograft groups were liver (41.1{\%}) and kidney (35.3{\%}). All-cause mortality at 90 days was 26.5{\%} for all species and was highest for Candida tropicalis (44{\%}) and C. parapsilosis (35.2{\%}). Non-white race and female gender were more commonly associated with non-albicans species. A high rate of breakthrough IC was seen in patients receiving antifungal prophylaxis (39{\%}). Factors associated with mortality include organ dysfunction, lung transplant, and treatment with a polyene antifungal. The only modifiable factor identified was choice of antifungal drug class based upon infecting Candida species. Conclusion: These data highlight the common and distinct features of IC in OTRs.",
keywords = "Candida, solid organ transplant",
author = "{The TRANSNET Investigators} and Andes, {David R.} and Nasia Safdar and Baddley, {John W.} and Barbara Alexander and Lisa Brumble and Freifeld, {Alison Gail} and Susan Hadley and Loreen Herwaldt and Carol Kauffman and Lyon, {G. Marshall} and Vicki Morrison and Thomas Patterson and Trish Perl and Randall Walker and Tim Hess and Tom Chiller and Pappas, {Peter G.}",
year = "2016",
month = "12",
day = "1",
doi = "10.1111/tid.12613",
language = "English (US)",
volume = "18",
pages = "921--931",
journal = "Transplant Infectious Disease",
issn = "1398-2273",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - The epidemiology and outcomes of invasive Candida infections among organ transplant recipients in the United States

T2 - results of the Transplant-Associated Infection Surveillance Network (TRANSNET)

AU - The TRANSNET Investigators

AU - Andes, David R.

AU - Safdar, Nasia

AU - Baddley, John W.

AU - Alexander, Barbara

AU - Brumble, Lisa

AU - Freifeld, Alison Gail

AU - Hadley, Susan

AU - Herwaldt, Loreen

AU - Kauffman, Carol

AU - Lyon, G. Marshall

AU - Morrison, Vicki

AU - Patterson, Thomas

AU - Perl, Trish

AU - Walker, Randall

AU - Hess, Tim

AU - Chiller, Tom

AU - Pappas, Peter G.

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Background: Invasive candidiasis (IC) is a common cause of mortality in solid organ transplant recipients (OTRs), but knowledge of epidemiology in this population is limited. Method: The present analysis describes data from 15 US centers that prospectively identified IC from nearly 17 000 OTRs. Analyses were undertaken to determine predictors of infection and mortality. Results: A total of 639 cases of IC were identified. The most common species was Candida albicans (46.3%), followed by Candida glabrata (24.4%) and Candida parapsilosis (8.1%). In 68 cases >1 species was identified. The most common infection site was bloodstream (44%), followed by intra-abdominal (14%). The most frequently affected allograft groups were liver (41.1%) and kidney (35.3%). All-cause mortality at 90 days was 26.5% for all species and was highest for Candida tropicalis (44%) and C. parapsilosis (35.2%). Non-white race and female gender were more commonly associated with non-albicans species. A high rate of breakthrough IC was seen in patients receiving antifungal prophylaxis (39%). Factors associated with mortality include organ dysfunction, lung transplant, and treatment with a polyene antifungal. The only modifiable factor identified was choice of antifungal drug class based upon infecting Candida species. Conclusion: These data highlight the common and distinct features of IC in OTRs.

AB - Background: Invasive candidiasis (IC) is a common cause of mortality in solid organ transplant recipients (OTRs), but knowledge of epidemiology in this population is limited. Method: The present analysis describes data from 15 US centers that prospectively identified IC from nearly 17 000 OTRs. Analyses were undertaken to determine predictors of infection and mortality. Results: A total of 639 cases of IC were identified. The most common species was Candida albicans (46.3%), followed by Candida glabrata (24.4%) and Candida parapsilosis (8.1%). In 68 cases >1 species was identified. The most common infection site was bloodstream (44%), followed by intra-abdominal (14%). The most frequently affected allograft groups were liver (41.1%) and kidney (35.3%). All-cause mortality at 90 days was 26.5% for all species and was highest for Candida tropicalis (44%) and C. parapsilosis (35.2%). Non-white race and female gender were more commonly associated with non-albicans species. A high rate of breakthrough IC was seen in patients receiving antifungal prophylaxis (39%). Factors associated with mortality include organ dysfunction, lung transplant, and treatment with a polyene antifungal. The only modifiable factor identified was choice of antifungal drug class based upon infecting Candida species. Conclusion: These data highlight the common and distinct features of IC in OTRs.

KW - Candida

KW - solid organ transplant

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U2 - 10.1111/tid.12613

DO - 10.1111/tid.12613

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VL - 18

SP - 921

EP - 931

JO - Transplant Infectious Disease

JF - Transplant Infectious Disease

SN - 1398-2273

IS - 6

ER -