Journal Article

Zygomycosis in Solid Organ Transplant Recipients: A Prospective, Matched Case-Control Study to Assess Risks for Disease and Outcome

Terzi, Nicolas, Pursell, Kenneth J., Dubberke, Erik R., Bonatti, Hugo, Barron, Michelle A., Philippe, Bruno, Singh, Nina, Gupta, Krishan L., Humar, Abhi, Safdar, Nasia, Lortholary, Olivier, Forrest, Graeme, Houston, Sally, Muñoz, Patricia, Johnson, Leonard, Chatelet, Valérie, Kusne, Shimon, Aguado, Jose M., Blumberg, Emily, Fortun, Jesus, Clark, Nina, Lass-Flörl, Cornelia, John, George T., Martin-Davila, Pilar, Patel, Robin, Tabah, Alexis, Philit, François, Julia, Marino Blanes

2009

Overview

BackgroundClinical characteristics, risks, and outcomes in solid organ transplant (SOT) recipients with zygomycosis in the era of modern immunosuppressive and newer antifungal agent use have not been defined MethodsIn a matched case-controlled study, SOT recipients with zygomycosis were prospectively studied. The primary outcome measure was success (complete or partial response) at 90 days ResultsRenal failure (odds ratio [OR], 3.17; P=.010), diabetes mellitus (OR, 8.11; P<.001), and prior voriconazole and/or caspofungin use (OR, 4.41; P=.033) were associated with a higher risk of zygomycosis, whereas tacrolimus (OR, 0.23; P=.002) was associated with a lower risk of zygomycosis. Liver transplant recipients were more likely to have disseminated disease (OR, 5.48; P=.021) and developed zygomycosis earlier after transplantation than did other SOT recipients (median, 0.8 vs 5.7 months; P<.001). Overall the treatment success rate was 60%. Renal failure (OR, 11.3; P=.023) and disseminated disease (OR, 14.6; P=.027) were independently predictive of treatment failure, whereas surgical resection was associated with treatment success (OR, 33.3; P=.003). The success rate with liposomal amphotericin B was 4-fold higher even when controlling for the aforementioned variables ConclusionsThe risks identified for zygomycosis and for disseminated disease, including those that were previously unrecognized, have implications for further elucidating the biologic basis and for optimizing outcomes in SOT recipients with zygomycosis

• Publisher: The University of Chicago Press,University of Chicago Press,Oxford University Press
• Subject: Aged / Antifungal Agents - therapeutic use / Antifungals / Biological and medical sciences / Case-Control Studies / Disease risk / Female / Fundamental and applied biological sciences. Psychology / Fungal infections / FUNGI / Health outcomes / Human mycoses / Humans / Immunocompromised Host / Immunosuppressive Agents - pharmacology / Infectious diseases / Liver / Lung diseases / Male / Medical sciences / Microbiology / Middle Aged / Mycoses / Nervous system diseases / Operating rooms / Organ Transplantation - adverse effects / Phycomycoses / Postoperative Complications - microbiology / Prospective Studies / Risk Factors / Transplantation / Tropical mycoses / Zygomycosis / Zygomycosis - epidemiology / Zygomycosis - etiology / Zygomycosis - prevention & control