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Analysis of Risk Factors for Invasive Mold Infections in Lung Transplant Recipients
Abstracts
S315 incidence of approximately 12% in the literature. Median time to development of IMI occurred later than 3 months; thus patients with mold colonizations prior to transplant may warrant longer durations of systemic prophylaxis.
Matrix showing relative effects of each treatment on the odds of IA in a mixed treatment comparison Liposomal amphotericin B Liposomal amphotericin
Voriconazole
Itraconazole
Isavuconazole
No treatment
3.62 (0.42
6.63 (0.65
2.14 (0.08
9.00 (1.84
- 31.32)
- 67.65)
- 60.62)
- 43.94)
B Voriconazole
0.28 (0.03
1.83 (0.38
0.59 (0.05
- 2.39)
- 8.88)
- 7.60)
Itraconazole
0.15 (0.01 - 1.54)
- 2.64)
Isavuconazole
0.47 (0.02
1.69 (0.13
No treatment
0.11 (0.02
- 13.18) - 0.54)
0.55 (0.11
- 21.63) 0.40 (0.07 - 2.31)
0.32 (0.02 to 6.49) 3.09 (0.15 -
4.68)
14.32) 1.36 (0.21 8.60) 4.20 (0.19 -
62.09) 0.74 (0.12 -
2.49 (0.43 -
92.56) 0.24 (0.01 - 5.26)
783 Analysis of Risk Factors for Invasive Mold Infections in Lung Transplant Recipients J. Sullivan,1 N. Sharma,2 K. Patel,2 and A. Logan.2 1Jackson Memorial Hospital, Miami, FL; and the 2Tampa General Hospital, Tampa, FL. Purpose: The purpose of this study is to identify risk factors associated with the development of IMI compared to mold colonization. Methods: A single-center, retrospective chart review was conducted on patients who received a lung transplant (LTr) between January 2012 and January 2016. Patients colonized with molds or who had IMI at any point were included for comparison of risk factors and outcomes. Targeted antifungal prophylaxis with voriconazole for 3 months was initiated for patients colonized before transplant or those who had positive donor cultures. Results: A total of 150 patients were transplanted within the time period and 94 met inclusion criteria; 81 (54%) were colonized and 13 (8.7%) had IMI. IMI were more common in males; 65% vs 23%, p<0.01 and factors associated with development of IMI included intra-abdominal surgery after transplant (25.9% vs. 53.9%, p=0.04), colonization at index hospitalization (19.8% vs. 53.9%, p < 0.01), return to the OR within 72 hours of transplant (6.2% vs. 30.8%, p=0.02), and use of TPN after transplant (18.5% vs. 46.2%, p=0.03). The median time to development of mold colonization or IMI was 108 days compared to 237 days respectively (p=0.01). There was no difference in secondary outcomes including rejection and mortality. Conclusion: A relatively low incidence of IMI developed even with the conservative approach of targeted prophylaxis compared to the reported
784 Lung Transplantation for Patients with Cystic Fibrosis and Achromobacter xylosoxidans in the Lung Allocation Score Era E. Nolley,1 K. Robinson,1 J. Pilewski,1 P. Sanchez,2 J. D'Cunha,2 and M. Morrell.1 1Pulmonary Allergy and Critical Care, University of Pittsburgh, Pittsburgh, PA; and the 2Division of Lung Transplantation and Lung Failure, University of Pittsburgh, Pittsburgh, PA. Purpose: Lung transplantation is an accepted therapy for patients with end stage lung disease due to Cystic Fibrosis (CF). Up to ten percent of patients with CF are colonized with Achromobacter xylosoxidans, a gram negative organism that due to its intrinsic resistance to many antibiotics may affect negatively impact post-transplant outcomes. Methods: We conducted a retrospective cohort analysis of all patients receiving lung transplantation for CF from 6/2005-2015 at the University of Pittsburgh Medical Center. Patients with Burkholderia species were excluded. General and transplant related demographics, pre and post-transplant respiratory cultures, and cause of death were examined. Graft survival was measured through February 2018 or last follow-up. Descriptive statistics were used to compare baseline demographics using parametric and non-parametric tests. Survival was estimated and compared by Kaplan Meier analysis. Results: Twenty-nine percent (26/89) of patients had a history of Achromobacter infection prior to transplantation. Pre-transplantation, patients with Achromobacter had a slightly higher FEV1 (25.8 +/- 2.1 vs 22.3 +/0.07, p=0.031) but trended towards requiring more mechanical ventilation (42 vs 24%, p=0.081). Compared to patients without Achromobacter, there was not a statistically significant difference in 1 year (0.84 vs 0.94%) and
S315 incidence of approximately 12% in the literature. Median time to development of IMI occurred later than 3 months; thus patients with mold colonizations prior to transplant may warrant longer durations of systemic prophylaxis.
Matrix showing relative effects of each treatment on the odds of IA in a mixed treatment comparison Liposomal amphotericin B Liposomal amphotericin
Voriconazole
Itraconazole
Isavuconazole
No treatment
3.62 (0.42
6.63 (0.65
2.14 (0.08
9.00 (1.84
- 31.32)
- 67.65)
- 60.62)
- 43.94)
B Voriconazole
0.28 (0.03
1.83 (0.38
0.59 (0.05
- 2.39)
- 8.88)
- 7.60)
Itraconazole
0.15 (0.01 - 1.54)
- 2.64)
Isavuconazole
0.47 (0.02
1.69 (0.13
No treatment
0.11 (0.02
- 13.18) - 0.54)
0.55 (0.11
- 21.63) 0.40 (0.07 - 2.31)
0.32 (0.02 to 6.49) 3.09 (0.15 -
4.68)
14.32) 1.36 (0.21 8.60) 4.20 (0.19 -
62.09) 0.74 (0.12 -
2.49 (0.43 -
92.56) 0.24 (0.01 - 5.26)
783 Analysis of Risk Factors for Invasive Mold Infections in Lung Transplant Recipients J. Sullivan,1 N. Sharma,2 K. Patel,2 and A. Logan.2 1Jackson Memorial Hospital, Miami, FL; and the 2Tampa General Hospital, Tampa, FL. Purpose: The purpose of this study is to identify risk factors associated with the development of IMI compared to mold colonization. Methods: A single-center, retrospective chart review was conducted on patients who received a lung transplant (LTr) between January 2012 and January 2016. Patients colonized with molds or who had IMI at any point were included for comparison of risk factors and outcomes. Targeted antifungal prophylaxis with voriconazole for 3 months was initiated for patients colonized before transplant or those who had positive donor cultures. Results: A total of 150 patients were transplanted within the time period and 94 met inclusion criteria; 81 (54%) were colonized and 13 (8.7%) had IMI. IMI were more common in males; 65% vs 23%, p<0.01 and factors associated with development of IMI included intra-abdominal surgery after transplant (25.9% vs. 53.9%, p=0.04), colonization at index hospitalization (19.8% vs. 53.9%, p < 0.01), return to the OR within 72 hours of transplant (6.2% vs. 30.8%, p=0.02), and use of TPN after transplant (18.5% vs. 46.2%, p=0.03). The median time to development of mold colonization or IMI was 108 days compared to 237 days respectively (p=0.01). There was no difference in secondary outcomes including rejection and mortality. Conclusion: A relatively low incidence of IMI developed even with the conservative approach of targeted prophylaxis compared to the reported
784 Lung Transplantation for Patients with Cystic Fibrosis and Achromobacter xylosoxidans in the Lung Allocation Score Era E. Nolley,1 K. Robinson,1 J. Pilewski,1 P. Sanchez,2 J. D'Cunha,2 and M. Morrell.1 1Pulmonary Allergy and Critical Care, University of Pittsburgh, Pittsburgh, PA; and the 2Division of Lung Transplantation and Lung Failure, University of Pittsburgh, Pittsburgh, PA. Purpose: Lung transplantation is an accepted therapy for patients with end stage lung disease due to Cystic Fibrosis (CF). Up to ten percent of patients with CF are colonized with Achromobacter xylosoxidans, a gram negative organism that due to its intrinsic resistance to many antibiotics may affect negatively impact post-transplant outcomes. Methods: We conducted a retrospective cohort analysis of all patients receiving lung transplantation for CF from 6/2005-2015 at the University of Pittsburgh Medical Center. Patients with Burkholderia species were excluded. General and transplant related demographics, pre and post-transplant respiratory cultures, and cause of death were examined. Graft survival was measured through February 2018 or last follow-up. Descriptive statistics were used to compare baseline demographics using parametric and non-parametric tests. Survival was estimated and compared by Kaplan Meier analysis. Results: Twenty-nine percent (26/89) of patients had a history of Achromobacter infection prior to transplantation. Pre-transplantation, patients with Achromobacter had a slightly higher FEV1 (25.8 +/- 2.1 vs 22.3 +/0.07, p=0.031) but trended towards requiring more mechanical ventilation (42 vs 24%, p=0.081). Compared to patients without Achromobacter, there was not a statistically significant difference in 1 year (0.84 vs 0.94%) and