Transplantation |

Candida Surgical Site Infections Post Lung Transplant FREE TO VIEW

Shruti Gadre; Marie Budev; Christine Koval
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Internal Medicine, Cleveland Clinic Ohio, Cleveland, OH

Chest. 2014;146(4_MeetingAbstracts):981A. doi:10.1378/chest.1991891
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SESSION TITLE: Lung Transplantation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Limited data exists regarding the incidence of candida surgical site infection (SSI) (incisional infections) in the lung transplant recipient (LTR). The objective of this study was to investigate the risk factors and outcomes in lung transplant recipients who develop candida SSIs.

METHODS: Retrospective chart review of lung transplant recipients from January 2000 to November 2013 (n=1053) was performed and demographic and microbiological data was obtained.

RESULTS: Five patients (n=3 IPF, n=1 CF, n=1 PHTN) developed Candida SSI early after transplant. The majority of patient were hospitalized pre transplant (n=4), with n=3 exposed to antibiotics and high dose steroids and n=1 exposed to azathioprine in the 3 months prior to transplant. None of the patients were exposed to antifungal medications prior to transplant. The majority of the recipients were diabetic (n=4). ECMO bridge to transplant was used in 3 patients and 2 patients needed ECMO support post transplant. All patients underwent a double lung transplant on cardiopulmonary bypass (median sternotomy n=4, clamshell n=1) with 2 patients needing to have an open chest post transplant. The intraoperative swab was positive for candida in n = 1 recipient and n =3 donor. Pretransplant sputum was positive for candida in n=3 recipients. None of the patients had a history of invasive candida infections prior to transplant. The majority of patients received prophylaxis with inhaled amphotericin B and PO itraconazole after lung transplant. One patient received IV micafungin for prophylaxis. All the sternal wound cultures grew Candida albicans. Treatment for candida infections varied with n=1 PO fluconazole and n=4 IV micafungin or PO voriconazole. Two of the sternal wound infections needed surgical wound debridement with removal of sternal wires. Only one patient had candida mediastinitis needing debridement but none of the patients had osteomyelitis. The mean duration of ICU stay was 19.2 days (16-24 days) and the mean duration of hospital stay was 62.2 days (29-95days) in the cohort. All patients survived initial hospitalization and were discharged from the hospital.

CONCLUSIONS: Sternal candida wound infections are uncommon post lung transplant. History of diabetes, exposure to steroids, antibiotics may be associated with candida SSIs.

CLINICAL IMPLICATIONS: Though uncommon, candida SSI may be associated with significant morbidity. Larger cohorts are needed to further explore risk factors and outcomes associated with candida SSIs.

DISCLOSURE: The following authors have nothing to disclose: Shruti Gadre, Marie Budev, Christine Koval

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