Práticas de profilaxia antifúngica e epidemiologia das infecções fúngicas no transplante hepático

• Ano de defesa: 2010
• Autor(a) principal: Zicker, Michelle [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Fatores de risco; Micoses/Epidemiologia; Prevenção primária; Transplante de fígado/Estatística e dados
• Link de acesso: http://repositorio.unifesp.br/handle/11600/9952

Objectives: the aims of this study were to determine the incidence and epidemiology of fungal infection in liver transplant recipients; to describe and to compare the antifungal prophylaxis regimens regarding the requirement of late antifungal therapy, the incidence of fungal infection, graft loss and survival rates; to describe fungal infection breakthrough episodes and to determine the risk factors for developing invasive fungal infection (IFI) within 12 months of transplantation. Methods: this is a retrospective observational study. We analyzed the medical records of all liver transplant recipients above 18 years old who underwent liver transplantation at Hospital Israelita Albert Einstein, between 2002 and 2007. Results: A total of 596 liver transplants were performed in 540 patients. Overall, 106 fungal infections occurred in 95 (18%) patients. Among the 106 fungal infections, there were 40 IFI that occurred in 37 patients (7%). Candida and Aspergillus species were the commonest etiologic agents. Candida species accounted for 87% of all fungal infection and for 67,5 of all invasive fungal infections, while Aspergillus species accounted for 7% of all fungal infections and for 17,5 of all invasive fungal infections. Only 138 patients received antifungal prophylaxis and among them 135 received fluconazole at 50 mg, 100 mg or 200 mg daily; amphotericin B was given at 10 mg, 25 mg or 40 mg daily. Systemic antifungal prophylaxis reduced the incidence of superficial (15% vs. 4%; p = 0,001) and IFI (9% vs. 3%; p=0,019)and the requirement of late antifungal therapy (67% vs. 23%; p< 0,001), but it showed no benefit in the multivariate analysis. Fluconazole at 100 mg or lower doses reduced the incidence of early fungal infection mostly due to the decrease in the incidence of superficial fungal infections, when compared to patients who didn’t receive any kind of antifungal prophylaxis (3,2% vs. 18,9%; p< 0,001). There was no difference of outcome regarding patient survival and graft loss among all antifungal prophylaxis regimens. There were 3 IFI breakthroughs among the patients who received prophylactic fluconazole. Significantly associated risk factors for developing IFI within 12 months of transplantation were retransplantation (OR 4,7; CI 95% 2,0-11,3; p<0,001), fungal colonization (OR 20,6; CI 95% 6,6-54,4; p<0,001) and taking metronidazole (OR 4,8; CI 95% 2,2-10,5; p<0,001).Conclusions: there was a low incidence of invasive fungal infection which reflected a population with a few risk factors. Candida and Aspergillus were the commonest etiologic agents. Systemic antifungal prophylaxis reduced the incidence of invasive and superficial fungal infections and the requirement of late antifungal therapy, but showed no effect in the multivariate analysis. No kind of antifungal prophylaxis regimen affected overall mortality or graft loss. Retransplantation, fungal colonization and taking metronidazole were the identified risk factors for developing IFI within 12 months of transplantation.