Infections

Invasive Pneumococcal Infections in Adult Lung Transplant Recipients

We undertook a single center, retrospective cohort study to define the incidence, timing, clinical, and microbiologic features of IPI in lung transplant patients. Fourteen out of 220 recipients developed IPI at a median of 1.3 years after transplantation. All patients were receiving trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis at the time of diagnosis, and 10 (71%) had TMP-SMX-resistant isolates. All isolates were from the 23 valent polysaccharide vaccine-associated serogroups. The high incidence of IPI in lung transplant recipients is similar to that reported in kidney and heart recipients. Alternative prevention strategies, including use of the conjugated pneumococcal vaccine, should be explored in future studies. (Source:  ISI Journal Citation Reports 2003)

Background. Aerosolized administrations of amphotericin B deoxycholate (AmBd) and amphotericin B lipid complex (ABLC) in lung transplant recipients were compared for safety and tolerability. The incidence of invasive fungal infections in patients receiving aerosolized amphotericin B formulations as sole prophylaxis was determined.Methods. A prospective, randomized (1:1), double-blinded trial was conducted with 100 subjects. AmBd and ABLC were administered postoperatively by nebulizer at doses of 25 mg and 50 mg, respectively, which were doubled in mechanically ventilated patients. The planned treatment was once every day for 4 days, then once per week for 7 weeks. Subjects receiving AmBd were more likely to have experienced an adverse event Conclusions. Both aerosol AmBd and ABLC appear to be associated with a low rate of invasive  pulmonary fungal infection in the early posttransplant period. Patients receiving ABLC were less likely to experience a treatment-related adverse event.Invasive fungal infections (IFIs) in patients undergoing lung transplantation are relatively common and have been associated with significant attributable mortality. Therefore, several antifungal prophylactic strategies have been used in an attempt to reduce the impact of IFIs on patient survival. However, the use of systemic antifungal therapies may be limited by lack of in vitro activity against Aspergillus sp (fluconazole), drug interactions (itraconazole, voriconazole), significant treatment-limiting toxicities, and requirements for intravenous administration (amphotericin B, caspofungin). Intolerance leading to treatment discontinuation has been reported to be as high as
48% in one report with AmBd.  Therefore, it is important to compare the safety of various formulations of amphotericin B when used prophylactically in patients at increased risk of IFIs to determine the best preparation for use.(Source: Transplantation:  27 January 2004 )