Candidemia in solid organ transplant recipients in Spain: Epidemiological trends and determinants of outcome
Por:
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, Padilla, B, Pano-Pardo, J, Garcia-Rodriguez, J, Cerrada, C, Ryan, P, Campelo, C, Gil, I, Buendia, V, Gorricho, B, Alonso, M, Sanz, F, Romo, F, Gorgolas, M, Gadea, I, Losa, J, Delgado-Iribarren, A, Ramos, A, Romero, Y, Romero, I, Zaragoza, O, Cuenca-Estrella, M, Rodriguez-Bano, J, Suarez, A, Loza, A, Garcia, A, Martin-Mazuelos, E, de Pipaon, M, Garnacho, J, Ortiz, C, Chavez, M, Maroto, F, Peman, J, Blanquer, J, Camarena, J, Zaragoza, R, Abril, V, Gimeno, C, Hernandez, S, Ezpeleta, G, Bereciartua, E, Almaraz, J, Rivas, R, Ayarza, R, Planes, A, Ruiz-Camps, I, Mensa, J, Almela, M, Gurgui, M, Sanchez-Reus, F, Martinez-Montauti, J, Sierra, M, Horcajada, J, Sorli, L, Gomez, J, Gene, A, Urrea, M, Diaz-Martin, A, Puchades, F, Mularoni, A, Puerta-Alcalde, P, Morata, L, Rodriguez-Nunez, O, Guerrero, M, Carratala, J, Sabe, N, Ayats, J, Grau, I, Calabuig, E, Castro, I, Cuellar, S, Fortun, J, Martin-Davila, P, de la Pedrosa, E, Perez-Ayala, A, Losada, I, Navarro, D, Suarez, M, Martin-Gomez, M, Almirante, B, Rodriguez-Alvarez, R, Lopez-Soira, L, Vena, A, Valerio, M, Bouza, E, Guinea, J, Martin, C, CANDIPOP Project, CANDI Bundle Grp and GEIRAS GEMICOMED SEIMC REIPI
Ahead of Print:
1 oct 2019
Resumen:
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.
Filiaciones:
Fernandez-Ruiz, M:
Univ Complutense, Hosp Univ 12 Octubre, Inst Invest Hosp 12 Octubre Imas12, Unit Infect Dis, Madrid, Spain
Cardozo, C:
Univ Barcelona, IDIBAPS Inst Invest Biomed Agust Pi & Sunyer, Hosp Clin, Dept Infect Dis, Barcelona, Spain
Salavert, M:
Hosp Univ & Politecn La Fe, Unit Infect Dis, Valencia, Spain
Aguilar-Guisado, M:
Univ Seville, Inst Biomed Sevilla IBIS, Hosp Univ Virgen Rocio, Dept Infect Dis Microbiol & Prevent Med, Seville, Spain
Escola-Verge, L:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain
Munoz, P:
Univ Complutense, Inst Invest Sanitaria Gregorio Maranon, Hosp Gen Univ Gregorio Maranon, Dept Clin Microbiol & Infect Dis, Madrid, Spain
Gioia, F:
Univ Alcala De Henares, IRYCIS Inst Ramon & Cajal Invest Sanitaria, Hosp Univ Ramon & Cajal, Dept Infect Dis, Madrid, Spain
Montejo, M:
Univ Basque Country, Hosp Univ Cruces, Unit Infect Dis, Bilbao, Spain
Merino, P:
Hosp Univ Clin San Carlos, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Dept Clin Microbiol, Madrid, Spain
Cuervo, G:
Univ Barcelona, IDIBELL Inst Invest Biomed Bellvitge, Hosp Univ Bellvitge, Dept Infect Dis, Barcelona, Spain
Garcia-Vidal, C:
Univ Barcelona, IDIBAPS Inst Invest Biomed Agust Pi & Sunyer, Hosp Clin, Dept Infect Dis, Barcelona, Spain
Aguado, J:
Univ Complutense, Hosp Univ 12 Octubre, Inst Invest Hosp 12 Octubre Imas12, Unit Infect Dis, Madrid, Spain
Padilla, B:
Hosp Gen Univ Gregorio Maranon, Madrid, Spain
Pano-Pardo, J:
Hosp Univ La Paz, Madrid, Spain
Garcia-Rodriguez, J:
Hosp Univ La Paz, Madrid, Spain
Cerrada, C:
Hosp Univ La Paz, Madrid, Spain
Ryan, P:
Hosp Univ Infanta Leonor, Madrid, Spain
Campelo, C:
Hosp Univ Infanta Leonor, Madrid, Spain
Gil, I:
Hosp Univ La Princesa, Madrid, Spain
Gorricho, B:
Hosp Univ Nino Jesus, Madrid, Spain
Alonso, M:
Hosp Univ Nino Jesus, Madrid, Spain
Sanz, F:
Hosp Univ 12 Octubre, Madrid, Spain
Romo, F:
Hosp Clin San Carlos, Madrid, Spain
Gorgolas, M:
Fdn Jimenez Diaz, Madrid, Spain
Gadea, I:
Fdn Jimenez Diaz, Madrid, Spain
Losa, J:
Hosp Alcorcon, Madrid, Spain
Delgado-Iribarren, A:
Hosp Alcorcon, Madrid, Spain
Ramos, A:
Hosp Univ Puerta Hierro Majadahonda, Madrid, Spain
Romero, Y:
Hosp Univ Puerta Hierro Majadahonda, Madrid, Spain
Romero, I:
Hosp Univ Puerta Hierro Majadahonda, Madrid, Spain
Zaragoza, O:
Inst Salud Carlos III, Ctr Nacl Microbiol, Madrid, Spain
Cuenca-Estrella, M:
Inst Salud Carlos III, Ctr Nacl Microbiol, Madrid, Spain
Rodriguez-Bano, J:
Hosp Univ Virgen Macarena, Seville, Spain
Suarez, A:
Hosp Univ Virgen Macarena, Seville, Spain
Loza, A:
Hosp Univ Virgen Valme, Seville, Spain
Garcia, A:
Hosp Univ Virgen Valme, Seville, Spain
Martin-Mazuelos, E:
Hosp Univ Virgen Valme, Seville, Spain
de Pipaon, M:
Hosp Univ Virgen Rocio, Seville, Spain
Garnacho, J:
Hosp Univ Virgen Rocio, Seville, Spain
Ortiz, C:
Hosp Quiron Sagrado Corazon, Seville, Spain
Chavez, M:
Hosp San Juan Dios Aljarafe, Seville, Spain
Maroto, F:
Hosp San Juan Dios Aljarafe, Seville, Spain
Peman, J:
Hosp Univ & Politecn La Fe, Valencia, Spain
Blanquer, J:
Hosp Clin Univ, Valencia, Spain
:
Hosp Univ Dr Peset, Valencia, Spain
:
Hosp Univ Dr Peset, Valencia, Spain
Abril, V:
Consorcio Hosp Gen Univ Valencia, Valencia, Spain
Gimeno, C:
Consorcio Hosp Gen Univ Valencia, Valencia, Spain
Hernandez, S:
Hosp Basurto, Bilbao, Spain
Ezpeleta, G:
Hosp Basurto, Bilbao, Spain
Bereciartua, E:
Hosp Univ Cruces, Bilbao, Spain
Almaraz, J:
Hosp Univ Cruces, Bilbao, Spain
Rivas, R:
Hosp Galdakano, Bilbao, Spain
Ayarza, R:
Hosp Galdakano, Bilbao, Spain
Planes, A:
Hosp Univ Vall dHebron, Barcelona, Spain
Ruiz-Camps, I:
Hosp Univ Vall dHebron, Barcelona, Spain
Mensa, J:
Hosp Clin IdiBAPS, Barcelona, Spain
Almela, M:
Hosp Clin IdiBAPS, Barcelona, Spain
Gurgui, M:
Hosp Univ St Pau & Santa Creu, Barcelona, Spain
Sanchez-Reus, F:
Hosp Univ St Pau & Santa Creu, Barcelona, Spain
Martinez-Montauti, J:
Hosp Barcelona, Barcelona, Spain
Sierra, M:
Hosp Barcelona, Barcelona, Spain
Horcajada, J:
Hosp del Mar, Barcelona, Spain
Sorli, L:
Hosp del Mar, Barcelona, Spain
Gomez, J:
Hosp del Mar, Barcelona, Spain
Gene, A:
Hosp St Joan de Deu, Barcelona, Spain
Urrea, M:
Hosp St Joan de Deu, Barcelona, Spain
Puerta-Alcalde, P:
Hosp Clin IdiBAPS, Barcelona, Spain
Morata, L:
Hosp Clin IdiBAPS, Barcelona, Spain
Rodriguez-Nunez, O:
Hosp Clin IdiBAPS, Barcelona, Spain
Guerrero, M:
Hosp Clin IdiBAPS, Barcelona, Spain
Carratala, J:
Hosp Univ Bellvitge, IDIBELL, Barcelona, Spain
Sabe, N:
Hosp Univ Bellvitge, IDIBELL, Barcelona, Spain
Ayats, J:
Hosp Univ Bellvitge, IDIBELL, Barcelona, Spain
Grau, I:
Hosp Univ Bellvitge, IDIBELL, Barcelona, Spain
Calabuig, E:
Hosp Univ & Politecn La Fe, Valencia, Spain
Castro, I:
Hosp Univ & Politecn La Fe, Valencia, Spain
Cuellar, S:
Hosp Univ & Politecn La Fe, Valencia, Spain
Fortun, J:
Hosp Univ Ramon & Cajal, Madrid, Spain
Martin-Davila, P:
Hosp Univ Ramon & Cajal, Madrid, Spain
de la Pedrosa, E:
Hosp Univ Ramon & Cajal, Madrid, Spain
Perez-Ayala, A:
Hosp Univ 12 Octubre, Madrid, Spain
Losada, I:
Hosp Univ 12 Octubre, Madrid, Spain
Navarro, D:
Hosp Clin Univ, Valencia, Spain
Suarez, M:
Hosp Clin Univ, Valencia, Spain
Martin-Gomez, M:
Hosp Univ Vall dHebron, Barcelona, Spain
Almirante, B:
Hosp Univ Vall dHebron, Barcelona, Spain
Rodriguez-Alvarez, R:
Hosp Univ Cruces, Bilbao, Spain
Lopez-Soira, L:
Hosp Univ Cruces, Bilbao, Spain
Vena, A:
Hosp Gen Univ Gregorio Maranon, Madrid, Spain
Valerio, M:
Hosp Gen Univ Gregorio Maranon, Madrid, Spain
Bouza, E:
Hosp Gen Univ Gregorio Maranon, Madrid, Spain
Guinea, J:
Hosp Gen Univ Gregorio Maranon, Madrid, Spain
Martin, C:
Hosp Univ Virgen Rocio, Seville, Spain
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