IDWeek 2019 — Universal fungal prophylaxis reduces infections after lung transplant


  • Devona Williams, Pharm.D.
  • Conference Reports
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Takeaway

  • Standard universal fungal prophylaxis provided better efficacy compared with targeted prophylaxis based on colonization and culture results.

Why this matters

  • Lung transplant recipients are at high risk of invasive fungal infections (IFI).
  • Fungal prophylaxis strategies may vary among different transplant centers, and it is important to find the most efficacious prescribing protocol to prevent morbidity and mortality associated with IFI.

Study design

  • Retrospective chart review of patients who had received a lung transplant.
  • Universal prophylaxis patients were prescribed itraconazole.
  • Targeted prophylaxis patients were prescribed voriconazole, fluconazole, or micafungin based on characteristics of colonization, positive microbiology, or thymoglobulin use.
    • Voriconazole: colonization with aspergillus, bronchoalveolar lavage (BAL) positive for aspergillus, thymoglobulin therapy received.
    • Fluconazole or micafungin: donor culture positive for candida.
    • Fluconazole: Candida albicans positive on bronchoscopy.

Key results

  • IFI with targeted prophylaxis: 30.4%.
  • IFI with universal prophylaxis: 8.4%.
  • Proportion of patients free of IFI at 18 months was higher in the universal prophylaxis group, 0.89 vs 0.71 (P=.031).
  • There was no difference in OS at 18 months among the 2 groups.

Limitations

  • Single-center study.
  • Results presented at conference and not peer-reviewed.