TY - JOUR
T1 - Risk Factors Associated With Invasive Fungal Infections in Kidney Transplant Patients
AU - Leitheiser, Sara
AU - Harner, Andrew
AU - Waller, Jennifer L.
AU - Turrentine, Jake
AU - Baer, Stephanie
AU - Kheda, Mufaddal
AU - Nahman, N. Stanley
AU - Colombo, Rhonda E.
N1 - Funding Information:
Conflict of Interest: S.L. reports grant funding from the Medical College of Georgia and the Translational Research Program of the Department of Medicine during the conduct of the study. M.K. and N.S.N. report grant funding from Dialysis Clinic, Inc. during the conduct of the study. All other authors report no conflicts of interest. The results presented in this paper have not been published previously in whole or part, except in abstract format. Supported by the Medical Scholar's Program (SL) of the Medical College of Georgia, a reserve fund research grant from Dialysis Clinic, Inc (MK, NSN), and the Translational Research Program of the Department of Medicine. The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as official policy or interpretation of the US government. In addition, the contents do not represent the views of the Department of Veterans.
Publisher Copyright:
© 2019 Southern Society for Clinical Investigation
PY - 2020/2
Y1 - 2020/2
N2 - Background: Kidney transplant recipients are at increased risk for developing invasive fungal infections (IFI). We queried the United States Renal Data System (USRDS) for risk factors for IFI in these patients. Methods: Patients who underwent a kidney transplant between 2005 and 2008 were queried for an IFI diagnosis using ICD-9 codes. An IFI was defined as at least one documented diagnosis from one of the following: (1) Candida (candidemia); (2) Histoplasmosis; (3) Aspergillosis; (4) Cryptococcosis; (5) “Other” mycoses. Potential risk factors included demographics, certain comorbidities and immunosuppressive medications. To examine the relative risk (RR), simple bivariate models were used, followed by a comprehensive full model to estimate the adjusted RR (aRR). Results: Of 57,188 kidney transplant patients, 1,218 had 1,343 IFI diagnoses, with a median time to infection of 495 days. “Other” mycoses accounted for the most IFI diagnoses (37%), followed by aspergillosis (22%). The risk for any IFI was increased with age ≥65 years. Diabetes (aRR = 1.71), bacterial pneumonia (aRR = 1.62) and UTI (aRR = 1.34) were the top 3 clinical risk factors for infection. Each of the IFI groups was also associated with individual risk factors. Therapy with mycophenolate mofetil was associated with a decreased risk of candidemia. Conclusions: Risk factors for IFI in renal transplant patients include demographic, medication-associated and clinical data, as well as organism-specific factors. These results offer an extensive clinical profile of risk for IFI, and may thus help inform the diagnosis and presumptive therapy of invasive fungal infections in renal transplant recipients.
AB - Background: Kidney transplant recipients are at increased risk for developing invasive fungal infections (IFI). We queried the United States Renal Data System (USRDS) for risk factors for IFI in these patients. Methods: Patients who underwent a kidney transplant between 2005 and 2008 were queried for an IFI diagnosis using ICD-9 codes. An IFI was defined as at least one documented diagnosis from one of the following: (1) Candida (candidemia); (2) Histoplasmosis; (3) Aspergillosis; (4) Cryptococcosis; (5) “Other” mycoses. Potential risk factors included demographics, certain comorbidities and immunosuppressive medications. To examine the relative risk (RR), simple bivariate models were used, followed by a comprehensive full model to estimate the adjusted RR (aRR). Results: Of 57,188 kidney transplant patients, 1,218 had 1,343 IFI diagnoses, with a median time to infection of 495 days. “Other” mycoses accounted for the most IFI diagnoses (37%), followed by aspergillosis (22%). The risk for any IFI was increased with age ≥65 years. Diabetes (aRR = 1.71), bacterial pneumonia (aRR = 1.62) and UTI (aRR = 1.34) were the top 3 clinical risk factors for infection. Each of the IFI groups was also associated with individual risk factors. Therapy with mycophenolate mofetil was associated with a decreased risk of candidemia. Conclusions: Risk factors for IFI in renal transplant patients include demographic, medication-associated and clinical data, as well as organism-specific factors. These results offer an extensive clinical profile of risk for IFI, and may thus help inform the diagnosis and presumptive therapy of invasive fungal infections in renal transplant recipients.
KW - Infections
KW - Invasive fungal infection
KW - Kidney transplantation
KW - Risk factors
UR - http://www.scopus.com/inward/record.url?scp=85076622131&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85076622131&partnerID=8YFLogxK
U2 - 10.1016/j.amjms.2019.10.008
DO - 10.1016/j.amjms.2019.10.008
M3 - Article
C2 - 31836132
AN - SCOPUS:85076622131
SN - 0002-9629
VL - 359
SP - 108
EP - 116
JO - American Journal of the Medical Sciences
JF - American Journal of the Medical Sciences
IS - 2
ER -