Combination antifungal therapy for invasive aspergillosis in solid organ transplant recipients
Abstract number: R2512
Cervera C., Trullas J.C., Soto G., Linares L., Puig de la Bellacasa J., Navasa M., Mas A., Cofan F., Ricart M.J., Roig E., Agusti C., Moreno A.
Background: Invasive aspergillosis (IA) in solid-organ transplant (SOT) recipients is still a major cause of infectious-related mortality. Combination antifungal therapy (CAT) represents a new challenge due to the availability of new antifungal drugs. We evaluate the clinical characteristics and outcomes of SOT patients with IA treated with CAT. We compared the outcomes of this cohort with an historical cohort treated with monotherapy.
Methods: All cases of probable or proven IA in SOT treated with double antifungal therapy were compared with those treated with antifungal monotherapy.
Results: From 1998 to August 2007, 25 cases of definite or probable IA in SOT were diagnosed of which 13 (52%) received combined antifungal therapy (11 liposomal amphotericin B [lAmB] + caspofungin, 1 lAmB + itraconazole and 1 voriconazole + caspofungin). Monotherapy was based in Amphotericin B in all cases but one (treated with itraconazole). Diagnosis of IA was: 9 proven and 16 probable. Late-onset IA (more than 180 days post-transplant) represented 24% of the cases (6 cases). By type of SOT: 6 kidney, 15 liver, 3 kidney-pancreas and 1 heart. A. fumigatus was isolated in 19 patients, A. niger in 2, A. terreus in 1, Aspergillus spp. in 1 and in 2 patients no microbiologic isolation was found (1 case biopsy proven without culture and 1 case with two positive galactomannan and suggestive radiological findings). There were no differences between both groups of antifungal treatment and type of SOT, age, gender, number of proven diagnosis and disseminated infection. Death occurred in 67% (8 cases) of patients treated with monotherapy vs 23% (3 cases) in those treated with CAT (p = 0.028).
Conclusions: Our results suggest a better outcome of SOT patients with IA treated with CAT. Randomized studies to evaluate the efficacy of CAT in IA are needed.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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