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实体器官移植受者侵袭性霉菌感染的流行病学特征:PATH Alliance® 注册研究分析

Epidemiological features of invasive mold infections among solid organ transplant recipients: PATH Alliance® registry analysis.

作者信息

Husain Shahid, Silveira Fernanda P, Azie Nkechi, Franks Billy, Horn David

机构信息

Multi-organ Transplant Program, Infectious Diseases Division, University Health Network, University of Toronto, 11 PMB 138, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.

Division of Infectious Diseases, University of Pittsburgh, Falk Medical Building, 3601 Fifth Avenue Suite 3A, Pittsburgh, PA, 15213, USA.

出版信息

Med Mycol. 2017 Apr 1;55(3):269-277. doi: 10.1093/mmy/myw086.

Abstract

Epidemiological characteristics of 333 proven and probable invasive mould infections (IMIs) among solid organ transplant recipients (SOTRs) identified between 2004 and 2008 from the Prospective Antifungal Therapy Alliance (PATH) registry are presented. Liver transplant recipients (LTRs) had the lowest median time to IMIs (109 days; interquartile range [IQR] 24-611 days), the highest rate of disseminated disease (n/N = 18/33; 55%), and highest mortality (n/N = 21/33; 64%). Lung transplant recipients had highest median time to IMIs (486 days; IQR 117-1358 days) and lowest mortality (n/N = 31/184; 17%). Complete or partial response at week 12 in patients with invasive aspergillosis (IA) was 67% (n/N = 189/281), and 41% (n/N = 9/22) in mucormycosis patients. In the composite outcome of death or no response to therapy, LTRs had the worst outcome. Higher suspicion of mold infection and institution of appropriate antifungal prophylactic strategies are warranted, especially in high risk LTRs.

摘要

本文介绍了2004年至2008年间,从前瞻性抗真菌治疗联盟(PATH)登记处识别出的333例确诊和可能的实体器官移植受者(SOTR)侵袭性霉菌感染(IMI)的流行病学特征。肝移植受者(LTR)发生IMI的中位时间最短(109天;四分位间距[IQR]24 - 611天),播散性疾病发生率最高(n/N = 18/33;55%),死亡率最高(n/N = 21/33;64%)。肺移植受者发生IMI的中位时间最长(486天;IQR 117 - 1358天),死亡率最低(n/N = 31/184;17%)。侵袭性曲霉病(IA)患者在第12周时完全或部分缓解率为67%(n/N = 189/281),毛霉菌病患者为41%(n/N = 9/22)。在死亡或治疗无反应的复合结局中,LTR的结局最差。对于霉菌感染应提高怀疑程度并采取适当的抗真菌预防策略,尤其是在高危LTR中。

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