Background: Invasive fungal infections are a leading cause of infection-related morbidity and mortality among transplant recipients. The decision to provide prophylaxis to a transplant population is based on the potential benefit (preventing a predictable invasive yeast or mold infection that will occur with relative frequency) and weighed against potential risks (toxicity and cost of the preventative regimen). Solid organ transplant: Suppression of Candida growth at the time of surgical manipulation of the bowel is the foundation for prevention of yeast infection in intra-abdominal organ transplantation. Fluconazole is effective and safe at 100-400 mg daily for the first 1-3 months. Prevention strategies toward aspergillus infection remain elusive, especially for lung & liver transplant recipients. Newer manipulations include the use of inhaled liposomal amphotericin preparations and itraconazole. Hematopoietic cell transplant: Fluconazole prophylaxis at 200-400 mg daily until engraftment is considered standard. However, this agent has no activity against molds. New antifungal drug choices for these patients include itraconazole, micafungin, & voriconazole. Preventative strategies may involve extending the duration of prophylaxis when the agent covers molds, combining these agents with new diagnostic markers and/or low-dose amphotericin B (0.5 mg/kg 3 times weekly), and using different agents at different time intervals following transplantation. Overall, algorithms for fungal prophylaxis among transplant patients are constantly evolving as the epidemiology and diagnostic and therapeutic options change.
Full conference title:
43rd Interscience Conference on Antimicrobial Agents
- ICAAC 43rd