Bassetti Matteo, Peghin Maddalena, Carnelutti Alessia, Righi Elda, Merelli Maria, Ansaldi Filippo, Trucchi Cecilia, Alicino Cristiano, Sartor Assunta, Wauters Joost, Lagrou Katrien, Tascini Carlo, Menichetti Francesco, Mesini Alessio, De Rosa Francesco G, Lagunes Leonel, Rello Jordi, Colombo Arnaldo L, Vena Antonio, Munoz Patricia, Tumbarello Mario, Sganga Gabriele, Martin-Loeches Ignacio, Viscoli Claudio
Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
Department of Health Sciences, University of Genoa, Genoa, Italy.
Transplant Direct. 2017 Apr 18;3(5):e156. doi: 10.1097/TXD.0000000000000673. eCollection 2017 May.
Invasive fungal infections remain a leading cause of morbidity and mortality among liver transplant recipients (LTRs). In this patient population, invasive Candida infections (ICIs) account for the large majority of cases. To date, only small studies and case-series analysing clinical presentation and risk factors for mortality in LTRs with ICIs are available.
We performed a retrospective multicenter multinational study in 10 centers in Europe and Brazil. All consecutive LTRs developing ICIs during the period January 2011 to December 2013 were included in the study.
A total of 42 LTRs were included. Median age was 52.5 years, and 78.6% of patients were men. Viral hepatitis was the most common cause for liver transplantation (42.9%). Candidemia represented the majority of cases (24, 57.1%), followed by intra-abdominal candidiasis (18, 42.9%). Overall 30-day mortality was 23.8%, with higher mortality in patients with candidemia compared with intra-abdominal candidiasis (37.5% vs 5.6%, = 0.02). Multivariate analysis showed candidemia to be a risk factor associated with mortality among LTRs presenting ICIs (odds ratio, 11.86; 95% confidence interval, 1.5-280; = 0.01). represented the most common isolate (59.5%). High rates of antifungal resistances were found, with 16.7% and 4.8% of isolates displaying resistance to azoles and caspofungin, respectively.
Our study confirms the occurrence of high mortality rates in LTRs developing ICIs. Mortality rates varied according to the type of infection, with candidemia representing a risk factor for mortality. The high rates of antifungal resistance should be considered in the choice of the empiric antifungal regimen.
侵袭性真菌感染仍然是肝移植受者（LTRs）发病和死亡的主要原因。在这一患者群体中，侵袭性念珠菌感染（ICIs）占大多数病例。迄今为止，仅有少量研究和病例系列分析了ICIs肝移植受者的临床表现和死亡风险因素。
我们在欧洲和巴西的10个中心进行了一项回顾性多中心跨国研究。纳入2011年1月至2013年12月期间发生ICIs的所有连续肝移植受者。
共纳入42例肝移植受者。中位年龄为52.5岁，78.6%的患者为男性。病毒性肝炎是肝移植最常见的原因（42.9%）。念珠菌血症占大多数病例（24例，57.1%），其次是腹腔内念珠菌病（18例，42.9%）。总体30天死亡率为23.8%，念珠菌血症患者的死亡率高于腹腔内念珠菌病患者（37.5%对5.6%，P = 0.02）。多变量分析显示，念珠菌血症是ICIs肝移植受者死亡的相关风险因素（比值比，11.86；95%置信区间，1.5 - 280；P = 0.01）。白色念珠菌是最常见的分离株（59.5%）。发现较高的抗真菌耐药率，分别有16.7%和4.8%的分离株对唑类和卡泊芬净耐药。
我们的研究证实了发生ICIs的肝移植受者死亡率较高。死亡率因感染类型而异，念珠菌血症是死亡的一个风险因素。在选择经验性抗真菌治疗方案时应考虑高抗真菌耐药率。
