Candidemia in solid organ transplant recipients in Spain: Epidemiological trends and determinants of outcome

Fernandez-Ruiz, M.; Cardozo, C.; Salavert, M.; Aguilar-Guisado, M.; Escola-Verge, L.; Munoz, P.; Gioia, F.; Montejo, M.; Merino, P.; Cuervo, G.; Garcia-Vidal, C.; Aguado, J. M.; Padilla, B.; Guinea, J.; Pano-Pardo, J. R.; Garcia-Rodriguez, J.; Garcia Cerrada, C.; Fortun, J.; Martin-Davila, P.; Gomez-Garcia de la Pedrosa, E.; Ryan, P.; Campelo, C.; de los Santos Gil, I.; Buendia, V.; Perez Gorricho, B.; Alonso, M.; Sanz Sanz, F.; Gonzalez Romo, F.; Gorgolas, M.; Gadea, I.; Delgado-Iribarren, A.; Ramos, A.; Romero, Y.; Sanchez Romero, I.; Zaragoza, O.; Cuenca-Estrella, M.; Rodriguez-Bano, J.; Suarez, A. I.; Loza, A.; Aller Garcia, A. I.; Martin-Mazuelos, E.; Ruiz Perez de Pipaon, M.; Garnacho, J.; Ortiz, C.; Chavez, M.; Maroto, F. L.; Peman, J.; Blanquer, J.; Navarro, D.; Camarena, J. J.; Zaragoza, R.; Abril, V.; Gimeno, C.; Hernandez, S.; Ezpeleta, G.; Bereciartua, E.; Hernandez Almaraz, J. L.; Rivas, R. A.; Ayarza, R.; Planes, A. M.; Ruiz-Camps, I.; Almirante, B.; Mensa, J.; Almela, M.; Gurgui, M.; Sanchez-Reus, F.; Martinez-Montauti, J.; Sierra, M.; Horcajada, J. P.; Sorli, L.; Gomez, J.; Gene, A.; Urrea, M.; Valerio, M.; Diaz-Martin, A.; Puchades, F.; Mularoni, A.; Puerta-Alcalde, P.; Morata, L.; Rodriguez-Nunez, O.; Guerrero, M. A.; Carratala, J.; Sabe, N.; Ayats, J.; Grau, I.; Calabuig, E.; Castro, I.; Cuellar, S.; Fortun, J.; Martin-Davila, P.; Gomez-Garcia de la Pedrosa, E.; Perez-Ayala, A.; Losada, I.; Navarro, D.; Suarez, M. I.; Martin-Gomez, M. T.; Almirante, B.; Rodriguez-Alvarez, R.; Lopez-Soira, L.; Vena, A.; Valerio, M.; Bouza, E.; Guinea, J.; Martin, C.

doi:10.1111/tid.13195

Background: Despite being considered a high-risk population for invasive fungal disease, specific features of candidemia among solid organ transplant (SOT) recipients remain poorly characterized. Methods: We compiled prospective data from two multicenter studies on candidemia performed over two consecutive periods in Spain: the CANDIPOP Study (2010-2011) and the CANDI-Bundle Study (2016-2018). Episodes diagnosed in adult SOT recipients in 10 participating centers were included. Risk factors for clinical failure (all-cause 7-day mortality and/or persistent candidemia for ≥72 hours) and 30-day mortality were investigated by univariate analysis. Results: We included 55 episodes of post-transplant candidemia (32 and 23 of which occurred during the first and second periods). Kidney (38.2%) and liver recipients (30.9%) were the most common populations. Candida albicans accounted for 27.3% of episodes. The proportion of C glabrata increased over time (18.8% vs 30.4% for the first and second periods). There were no differences in the rate of fluconazole non-susceptible isolates (50.0% vs 60.0%, respectively). Clinical failure and 30-day mortality occurred in 25.5% and 27.3% of episodes and were associated with the severity of candidemia (Pitt score and severe sepsis/septic shock). Kidney transplantation (unadjusted odds ratio [uOR]: 0.17; 95% confidence interval [CI]: 0.03-0.85; P-value =.020), early catheter removal (uOR: 0.15; 95% CI: 0.03-0.76; P-value =.013), and appropriate early antifungal therapy (uOR: 0.14; 95% CI: 0.02-0.89; P-value =.041) were protective for 30-day mortality. Conclusions: High rates of non-albicans species and fluconazole non-susceptibility must be taken into account to optimize therapeutic management and outcomes in SOT recipients with candidemia.

Candidemia in solid organ transplant recipients in Spain: Epidemiological trends and determinants of outcome

Fernandez-Ruiz M.;Cardozo C.;Salavert M.;Aguilar-Guisado M.;Escola-Verge L.;Munoz P.;Gioia F.;Montejo M.;Merino P.;Cuervo G.;Garcia-Vidal C.;Aguado J. M.;Padilla B.;Guinea J.;Pano-Pardo J. R.;Garcia-Rodriguez J.;Garcia Cerrada C.;Fortun J.;Martin-Davila P.;Gomez-Garcia de la Pedrosa E.;Ryan P.;Campelo C.;de los Santos Gil I.;Buendia V.;Perez Gorricho B.;Alonso M.;Sanz Sanz F.;Gonzalez Romo F.;Gorgolas M.;Gadea I.;Delgado-Iribarren A.;Ramos A.;Romero Y.;Sanchez Romero I.;Zaragoza O.;Cuenca-Estrella M.;Rodriguez-Bano J.;Suarez A. I.;Loza A.;Aller Garcia A. I.;Martin-Mazuelos E.;Ruiz Perez de Pipaon M.;Garnacho J.;Ortiz C.;Chavez M.;Maroto F. L.;Peman J.;Blanquer J.;Navarro D.;Camarena J. J.;Zaragoza R.;Abril V.;Gimeno C.;Hernandez S.;Ezpeleta G.;Bereciartua E.;Hernandez Almaraz J. L.;Rivas R. A.;Ayarza R.;Planes A. M.;Ruiz-Camps I.;Almirante B.;Mensa J.;Almela M.;Gurgui M.;Sanchez-Reus F.;Martinez-Montauti J.;Sierra M.;Horcajada J. P.;Sorli L.;Gomez J.;Gene A.;Urrea M.;Valerio M.;Diaz-Martin A.;Puchades F.;Mularoni A.;Puerta-Alcalde P.;Morata L.;Rodriguez-Nunez O.;Guerrero M. A.;Carratala J.;Sabe N.;Ayats J.;Grau I.;Calabuig E.;Castro I.;Cuellar S.;Fortun J.;Martin-Davila P.;Gomez-Garcia de la Pedrosa E.;Perez-Ayala A.;Losada I.;Navarro D.;Suarez M. I.;Martin-Gomez M. T.;Almirante B.;Rodriguez-Alvarez R.;Lopez-Soira L.;Vena A.;Valerio M.;Bouza E.;Guinea J.;Martin C.

2019-01-01

Abstract

Background: Despite being considered a high-risk population for invasive fungal disease, specific features of candidemia among solid organ transplant (SOT) recipients remain poorly characterized. Methods: We compiled prospective data from two multicenter studies on candidemia performed over two consecutive periods in Spain: the CANDIPOP Study (2010-2011) and the CANDI-Bundle Study (2016-2018). Episodes diagnosed in adult SOT recipients in 10 participating centers were included. Risk factors for clinical failure (all-cause 7-day mortality and/or persistent candidemia for ≥72 hours) and 30-day mortality were investigated by univariate analysis. Results: We included 55 episodes of post-transplant candidemia (32 and 23 of which occurred during the first and second periods). Kidney (38.2%) and liver recipients (30.9%) were the most common populations. Candida albicans accounted for 27.3% of episodes. The proportion of C glabrata increased over time (18.8% vs 30.4% for the first and second periods). There were no differences in the rate of fluconazole non-susceptible isolates (50.0% vs 60.0%, respectively). Clinical failure and 30-day mortality occurred in 25.5% and 27.3% of episodes and were associated with the severity of candidemia (Pitt score and severe sepsis/septic shock). Kidney transplantation (unadjusted odds ratio [uOR]: 0.17; 95% confidence interval [CI]: 0.03-0.85; P-value =.020), early catheter removal (uOR: 0.15; 95% CI: 0.03-0.76; P-value =.013), and appropriate early antifungal therapy (uOR: 0.14; 95% CI: 0.02-0.89; P-value =.041) were protective for 30-day mortality. Conclusions: High rates of non-albicans species and fluconazole non-susceptibility must be taken into account to optimize therapeutic management and outcomes in SOT recipients with candidemia.