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著者: Nina Singh, Jose M Aguado, Hugo Bonatti, Graeme Forrest, Krishan L Gupta, Nasia Safdar, George T John, Kenneth J Pursell, Patricia Muñoz, Robin Patel, Jesus Fortun, Pilar Martin-Davila, Bruno Philippe, François Philit, Alexis Tabah, Nicolas Terzi, Valérie Chatelet, Shimon Kusne, Nina Clark, Emily Blumberg, Marino Blanes Julia, Abhi Humar, Sally Houston, Cornelia Lass-Flörl, Leonard Johnson, Erik R Dubberke, Michelle A Barron, Olivier Lortholary
雑誌名: J Infect Dis. 2009 Sep 15;200(6):1002-11. doi: 10.1086/605445.
Abstract/Text
BACKGROUND: Clinical characteristics, risks, and outcomes in solid organ transplant (SOT) recipients with zygomycosis in the era of modern immunosuppressive and newer antifungal agent use have not been defined.
METHODS: In a matched case-controlled study, SOT recipients with zygomycosis were prospectively studied. The primary outcome measure was success (complete or partial response) at 90 days.
RESULTS: Renal failure (odds ratio [OR], 3.17; P = .010), diabetes mellitus (OR, 8.11; P < .001), and prior voriconazole and/or caspofungin use (OR, 4.41; P = .033) were associated with a higher risk of zygomycosis, whereas tacrolimus (OR, 0.23; P = .002) was associated with a lower risk of zygomycosis. Liver transplant recipients were more likely to have disseminated disease (OR, 5.48; P = .021) and developed zygomycosis earlier after transplantation than did other SOT recipients (median, 0.8 vs 5.7 months; P < .001). Overall the treatment success rate was 60%. Renal failure (OR, 11.3; P = .023) and disseminated disease (OR, 14.6; P = .027) were independently predictive of treatment failure, whereas surgical resection was associated with treatment success (OR, 33.3; P = .003). The success rate with liposomal amphotericin B was 4-fold higher even when controlling for the aforementioned variables.
CONCLUSIONS: The risks identified for zygomycosis and for disseminated disease, including those that were previously unrecognized, have implications for further elucidating the biologic basis and for optimizing outcomes in SOT recipients with zygomycosis.
PMID 19659439 J Infect Dis. 2009 Sep 15;200(6):1002-11. doi: 10.1086/605445.
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