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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Koo, Sophia Kubiak, David W. Issa, Nicolas C. Dietzek, Amanda Boukedes, Steve Camp, Phillip C. Goldberg, Hilary J. Baden, Lindsey R. Fuhlbrigge, Anne L. Marty, Francisco M. |
| Description | Country affiliation: United States Author Affiliation: Koo S ( Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. skoo@partners.org) |
| Abstract | BACKGROUND: Lung transplant recipients are at high risk of invasive fungal disease (IFD), particularly invasive aspergillosis and candidiasis. The antifungal strategy that optimally balances effective reduction of IFD with a minimum of toxicity remains undefined; universal triazole prophylaxis is common at lung transplantation (LT) centers, despite the well-known toxicities and costs of this approach. METHODS: We implemented an antifungal strategy in March 2007 targeted at LT recipients at highest risk for IFD based on our institutional epidemiology. All patients received inhaled amphotericin B during their initial LT hospitalization, bilateral lung transplant recipients received 7 to 10 days of micafungin, and only patients with growth of yeast or mold in their day-of-transplant cultures received further oral antifungal therapy tailored to their fungal isolate. RESULTS: IFD events were assessed in sequential cohorts composed of 82 lung transplant recipients before and 83 patients after the implementation of this targeted antifungal strategy. We observed a sharp decline in IFD; in the second cohort, 87%, 91%, and 96% of patients were free of IFD, invasive candidiasis, and invasive aspergillosis at 1 year. Only 19% of patients in the second cohort received systemic antifungal therapy beyond the initial LT hospitalization, and no patients experienced antifungal drug-related toxicity or IFD-associated mortality. CONCLUSIONS: The targeted antifungal strategy studied seems to be a reasonable approach to reducing post-LT IFD events while limiting treatment-related toxicities and costs. |
| File Format | HTM / HTML |
| ISSN | 00411337 |
| Issue Number | 3 |
| Volume Number | 94 |
| e-ISSN | 15346080 |
| Journal | Transplantation Journal |
| Language | English |
| Publisher | Lippincott Williams & Wilkins |
| Publisher Date | 2012-08-15 |
| Publisher Place | United States |
| Access Restriction | One Nation One Subscription (ONOS) |
| Subject Keyword | Discipline Transplantation Antifungal Agents Therapeutic Use Lung Transplantation Adverse Effects Methods Mycoses Etiology Prevention & Control Adult Aged Amphotericin B Aspergillosis Candidiasis Cohort Studies Echinocandins Female Humans Lipopeptides Male Middle Aged Risk Time Factors Triazoles Journal Article Research Support, Non-u.s. Gov't |
| Content Type | Text |
| Resource Type | Article |
| Subject | Transplantation |
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