Epidemiology of invasive respiratory disease caused by emerging non-Aspergillus molds in lung transplant recipients

M. Peghin, V. Monforte, M. T. Martin-Gomez, I. Ruiz-Camps, C. Berastegui, B. Saez, J. Riera, J. Solé, J. Gavaldá, A. Roman

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16 Citations (Scopus)

Abstract

© 2016 Wiley Periodicals, Inc. Objectives: Our aim was to assess the impact of positive cultures for non-Aspergillus molds on the risk of progression to invasive fungal infection (IFI), and the effect of prophylactic nebulized liposomal amphotericin B (n-LAB) on these pathogens. Methods: This was an observational study (2003-2013) including lung transplant recipients (LTR) receiving lifetime n-LAB prophylaxis, in whom non-Aspergillus molds were isolated on respiratory culture before and after transplantation (minimum 1-year follow-up). Results: We studied 412 patients, with a mean postoperative follow-up of 2.56 years (interquartile range 1.01-4.65). Pre- and post-transplantation respiratory samples were frequently positive for non-Aspergillus molds (11.9% and 16.9% of LTR respectively). Post transplantation, 10 (2.42%) patients developed non-Aspergillus mold infection (4 Scedosporium species, 4 Purpureocillium species, 1 Penicillium species, and 1 Scopulariopsis species); 5 (1.21%) had IFI, with 60% IFI-related mortality. Non-Aspergillus molds with intrinsic amphotericin B (AB) resistance were more commonly isolated in bronchoscopy samples than AB-variably sensitive or AB-sensitive molds (54.5% vs. 25%, P = 0.04) and were associated with a higher risk of infection (56.3% vs. 1.3%%, P < 0.01). Conclusions: In LTR undergoing n-LAB prophylaxis, pre- and post-transplantation isolation of non-Aspergillus molds is frequent, but IFI incidence (1.21%) is low. Purpureocillium is an emerging mold. AB-resistant non-Aspergillus species were found more often in bronchoscopy samples and were associated with a higher risk of infection.
Original languageEnglish
Pages (from-to)70-78
JournalTransplant Infectious Disease
Volume18
Issue number1
DOIs
Publication statusPublished - 1 Feb 2016

Keywords

  • Amphotericin B
  • Emerging fungi
  • Emerging molds
  • Fungal colonization
  • Invasive fungal infections
  • Lung transplant
  • Molds
  • Prophylaxis
  • Purpureocillium
  • Scedosporium

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