Invasive Aspergillosis among Lung Transplant Recipients during Time Periods with Universal and Targeted Antifungal Prophylaxis-A Nationwide Cohort Study
The optimal prevention strategy for invasive aspergillosis (IA) in lung transplant recipients (LTXr) is unknown. In 2016, the Danish guidelines were changed from universal to targeted IA prophylaxis. Previously, we found higher rates of adverse events in the universal prophylaxis period. In a Danish nationwide study including LTXr, for 2010-2019, we compared IA rates in time periods with universal vs. targeted prophylaxis and during person-time with vs. person-time without antifungal prophylaxis. IA hazard rates were analyzed in multivariable Cox models with adjustment for time after LTX. Among 295 LTXr, antifungal prophylaxis was initiated in 183/193 and 6/102 during the universal and targeted period, respectively. During the universal period, 62% discontinued prophylaxis prematurely. The median time on prophylaxis was 37 days (IQR 11-84). IA was diagnosed in 27/193 (14%) vs. 15/102 (15%) LTXr in the universal vs. targeted period, with an adjusted hazard ratio (aHR) of 0.94 (95% CI 0.49-1.82). The aHR of IA during person-time with vs. person-time without antifungal prophylaxis was 0.36 (95% CI 0.12-1.02). No difference in IA was found during periods with universal vs. targeted prophylaxis. Prophylaxis was protective of IA when taken. Targeted prophylaxis may be preferred over universal due to comparable IA rates and lower rates of adverse events.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:9 |
|---|---|
| Enthalten in: |
Journal of fungi (Basel, Switzerland) - 9(2023), 11 vom: 04. Nov. |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Crone, Cornelia Geisler [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Antifungal agents |
|---|
| Anmerkungen: |
Date Revised 27.11.2023 published: Electronic Citation Status PubMed-not-MEDLINE |
|---|
| doi: |
10.3390/jof9111079 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM364901381 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM364901381 | ||
| 003 | DE-627 | ||
| 005 | 20231226100513.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.3390/jof9111079 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1216.xml |
| 035 | |a (DE-627)NLM364901381 | ||
| 035 | |a (NLM)37998886 | ||
| 035 | |a (PII)1079 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Crone, Cornelia Geisler |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Invasive Aspergillosis among Lung Transplant Recipients during Time Periods with Universal and Targeted Antifungal Prophylaxis-A Nationwide Cohort Study |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 27.11.2023 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a The optimal prevention strategy for invasive aspergillosis (IA) in lung transplant recipients (LTXr) is unknown. In 2016, the Danish guidelines were changed from universal to targeted IA prophylaxis. Previously, we found higher rates of adverse events in the universal prophylaxis period. In a Danish nationwide study including LTXr, for 2010-2019, we compared IA rates in time periods with universal vs. targeted prophylaxis and during person-time with vs. person-time without antifungal prophylaxis. IA hazard rates were analyzed in multivariable Cox models with adjustment for time after LTX. Among 295 LTXr, antifungal prophylaxis was initiated in 183/193 and 6/102 during the universal and targeted period, respectively. During the universal period, 62% discontinued prophylaxis prematurely. The median time on prophylaxis was 37 days (IQR 11-84). IA was diagnosed in 27/193 (14%) vs. 15/102 (15%) LTXr in the universal vs. targeted period, with an adjusted hazard ratio (aHR) of 0.94 (95% CI 0.49-1.82). The aHR of IA during person-time with vs. person-time without antifungal prophylaxis was 0.36 (95% CI 0.12-1.02). No difference in IA was found during periods with universal vs. targeted prophylaxis. Prophylaxis was protective of IA when taken. Targeted prophylaxis may be preferred over universal due to comparable IA rates and lower rates of adverse events | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a antifungal agents | |
| 650 | 4 | |a aspergillosis | |
| 650 | 4 | |a invasive aspergillosis | |
| 650 | 4 | |a lung transplantation | |
| 650 | 4 | |a prophylaxis | |
| 650 | 4 | |a transplantation | |
| 650 | 4 | |a triazoles | |
| 650 | 4 | |a voriconazole | |
| 700 | 1 | |a Wulff, Signe Marie |e verfasserin |4 aut | |
| 700 | 1 | |a Ledergerber, Bruno |e verfasserin |4 aut | |
| 700 | 1 | |a Helweg-Larsen, Jannik |e verfasserin |4 aut | |
| 700 | 1 | |a Bredahl, Pia |e verfasserin |4 aut | |
| 700 | 1 | |a Arendrup, Maiken Cavling |e verfasserin |4 aut | |
| 700 | 1 | |a Perch, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Helleberg, Marie |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of fungi (Basel, Switzerland) |d 2014 |g 9(2023), 11 vom: 04. Nov. |w (DE-627)NLM25748468X |x 2309-608X |7 nnns |
| 773 | 1 | 8 | |g volume:9 |g year:2023 |g number:11 |g day:04 |g month:11 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.3390/jof9111079 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 9 |j 2023 |e 11 |b 04 |c 11 | ||