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- Results presented at conference and not peer-reviewed.