López-Medrano Francisco, Muñoz de la Espada María, Pérez-Jacoiste Asín María Asunción, Fernández-Ruiz Mario, Herrero-Martínez Juan María, Alonso-Carrillo Jesús, San Juan Rafael, Rodríguez-Goncer Isabel, Andrés Amado, González Esther, Manrique Alejandro, Justo Iago, Marcacuzco Alberto, Loinaz Carmelo, Jiménez Carlos, Lumbreras Carlos, Aguado José María
Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
Mycoses. 2022 May;65(5):517-525. doi: 10.1111/myc.13436. Epub 2022 Mar 15.
Invasive fungal infection, particularly intraabdominal candidiasis, exerts a negative impact on the outcome of pancreas transplant recipients (PTRs). Optimal antifungal prophylaxis in this context remains unclear.
We performed a single-centre retrospective study to compare the incidence of invasive candidiasis during the first 6 post-transplant months in a cohort of 218 PTRs over two periods in which different agents for antifungal prophylaxis were used: fluconazole (Fluco-Px) from March 1995 to June 2012, and micafungin followed by fluconazole (Mica-Px) from July 2012 to December 2018.
A total of 152 and 66 PTRs received Fluco-Px and Mica-Px. Mean age was 39.7 ± 7.8 years, 56.4% (123/218) were males, and 85.3% (186/218) underwent simultaneous pancreas-kidney transplantation. Invasive candidiasis occurred in 21.7% (33/152) of PTRs under Fluco-Px compared to 24.2% (16/66) of those under Mica-Px (p-value = .681). Median time from transplantation to infection was 8 days (interquartile range [IQR]: 6-16) under Fluco-Px versus 6.5 (IQR: 3.3-15.8) under Mica-Px (p-value = .623). Non-albicans Candida species comprised 27.5% (11/40) and 25.0% (4/16) of episodes under Fluco-Px and Mica-Px respectively (p-value = .849). Surgical site infection was the most common form in both groups (82.5% [33/40] and 87.5% [14/16]; p-value = .954). Multivariable analysis identified cold ischaemia time of the pancreas and kidney grafts, surgical reintervention and insulin requirement after transplantation as risks factor for invasive candidiasis.
This retrospective study did not reveal a significant benefit from the initial use of micafungin-based antifungal prophylaxis over fluconazole among PTRs in terms of invasive candidiasis.
侵袭性真菌感染，尤其是腹腔念珠菌病，对胰腺移植受者（PTR）的预后产生负面影响。在这种情况下，最佳的抗真菌预防措施仍不明确。
我们进行了一项单中心回顾性研究，比较了218例PTR在移植后前6个月内侵袭性念珠菌病的发生率，这218例患者分两个阶段，使用了不同的抗真菌预防药物：1995年3月至2012年6月使用氟康唑（氟康唑预防组），2012年7月至2018年12月使用米卡芬净随后使用氟康唑（米卡芬净预防组）。
共有152例和66例PTR分别接受了氟康唑预防和米卡芬净预防。平均年龄为39.7±7.8岁，56.4%（123/218）为男性，85.3%（186/218）接受了同期胰肾联合移植。氟康唑预防组中21.7%（33/152）的PTR发生了侵袭性念珠菌病，米卡芬净预防组为24.2%（16/66）（p值 = 0.681）。氟康唑预防组从移植到感染的中位时间为8天（四分位间距[IQR]：6 - 16），米卡芬净预防组为6.5天（IQR：3.3 - 15.8）（p值 = 0.623）。非白色念珠菌属在氟康唑预防组和米卡芬净预防组的感染病例中分别占27.5%（11/40）和25.0%（4/16）（p值 = 0.849）。手术部位感染是两组中最常见的形式（82.5%[33/40]和87.5%[14/16]；p值 = 0.954）。多变量分析确定胰腺和肾脏移植物的冷缺血时间、手术再次干预以及移植后胰岛素需求是侵袭性念珠菌病的危险因素。
这项回顾性研究未显示在PTR中，初始使用基于米卡芬净的抗真菌预防措施在侵袭性念珠菌病方面比氟康唑有显著益处。
