Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, MI, USA.
Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Transpl Infect Dis. 2021 Feb;23(1):e13448. doi: 10.1111/tid.13448. Epub 2020 Sep 1.
Antifungal prophylaxis to prevent invasive fungal infections (IFI) is widely used following lung transplantation, but the optimal strategy remains unclear. We compared universal with targeted antifungal prophylaxis for effectiveness in preventing IFI.
Adult patients who underwent lung transplantation at the University of Michigan from /1 July 2014-31 December 2017 were studied for 18 months post-transplant. Universal prophylaxis consisted of itraconazole with or without inhaled liposomal amphotericin B. Using specific criteria, targeted prophylaxis was given with voriconazole for patients at risk for invasive pulmonary aspergillosis (IPA) and with fluconazole or micafungin for patients at risk for invasive candidiasis. Risk factors, occurrence of proven/probable IFI, and mortality were analyzed for the two prophylaxis cohorts.
Of 105 lung transplant recipients, 84 (80%) received a double lung transplant, and 38 (36%) of patients underwent transplant for pulmonary fibrosis. Fifty-nine (56%) patients received universal antifungal prophylaxis, and 46 (44%), targeted antifungal prophylaxis. Among 20 proven/probable IFI, there were 14 IPA, 4 invasive candidiasis, 1 cryptococcosis, and 1 deep sternal mold infection. Six (10%) IFI occurred in the universal prophylaxis cohort and 14 (30%) in the targeted prophylaxis cohort. Five of 6 (83%) IFI in the universal prophylaxis cohort, compared with 9/14 (64%) in the targeted prophylaxis cohort, were IPA Candida infections occurred only in the targeted prophylaxis cohort. The development of IFI was more likely in the targeted prophylaxis cohort than the universal prophylaxis cohort, HR = 4.32 (1.51-12.38), P = .0064.
Universal antifungal prophylaxis appears to be more effective than targeted antifungal prophylaxis for prevention of IFI after lung transplant.
在肺移植后，广泛使用抗真菌预防来预防侵袭性真菌感染（IFI），但最佳策略仍不清楚。我们比较了通用与靶向抗真菌预防在预防 IFI 方面的有效性。
在密歇根大学进行肺移植的成年患者在移植后 18 个月内进行了研究。通用预防方案包括伊曲康唑和/或吸入性脂质体两性霉素 B。使用特定标准，对于有侵袭性肺曲霉病（IPA）风险的患者给予伏立康唑预防，对于有侵袭性念珠菌病风险的患者给予氟康唑或米卡芬净预防。分析了两组预防方案的危险因素、IFI 的确诊/疑似病例和死亡率。
在 105 例肺移植受者中，84 例（80%）接受了双肺移植，38 例（36%）患者因肺纤维化接受了移植。59 例（56%）患者接受了通用抗真菌预防，46 例（44%）接受了靶向抗真菌预防。在 20 例确诊/疑似 IFI 中，有 14 例 IPA、4 例侵袭性念珠菌病、1 例隐球菌病和 1 例深部胸骨霉菌感染。在通用预防组中发生了 6 例（10%）IFI，在靶向预防组中发生了 14 例（30%）。在通用预防组中，6 例（83%）IFI 中有 5 例，而在靶向预防组中，14 例（64%）IFI 中有 9 例为 IPA，仅在靶向预防组中发生了念珠菌感染。与通用预防组相比，靶向预防组发生 IFI 的可能性更大，HR=4.32（1.51-12.38），P=0.0064。
与靶向抗真菌预防相比，通用抗真菌预防似乎更能有效预防肺移植后的 IFI。
