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Risk Factors Associated With Invasive Fungal Infections in Kidney Transplant Patients
Sara Leitheiser1, Andrew Harner2, Jennifer L Waller3
1Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA.
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.
Insights
Kidney transplant patients face a higher risk of invasive fungal infections (IFI). Key risk factors include older age, diabetes, bacterial pneumonia, and urinary tract infections, informing diagnosis and treatment.
Area of Science:
- Nephrology
- Infectious Diseases
- Immunology
Background:
- Kidney transplant recipients (KTRs) are a vulnerable population with an elevated risk of invasive fungal infections (IFI).
- Understanding specific risk factors is crucial for preventing and managing IFI in KTRs.
Purpose of the Study:
- To identify demographic, clinical, and medication-associated risk factors for IFI in kidney transplant recipients.
- To analyze the incidence and types of IFI in KTRs using a large national database.
Main Methods:
- Retrospective analysis of the United States Renal Data System (USRDS) database.
- Inclusion of kidney transplant patients who underwent transplantation between 2005 and 2008.
- Identification of IFI cases using ICD-9 codes and categorization into specific fungal groups (Candida, Histoplasmosis, Aspergillosis, Cryptococcosis, Other mycoses).
- Statistical modeling to determine relative risks (RR) and adjusted relative risks (aRR) for various factors.
Main Results:
- A total of 57,188 KTRs were analyzed, with 1,218 experiencing 1,343 IFI diagnoses (median time to infection: 495 days).
- The most common IFI types were "Other" mycoses (37%) and Aspergillosis (22%).
- Increased risk for any IFI was associated with age ≥65 years. Top clinical risk factors included diabetes (aRR=1.71), bacterial pneumonia (aRR=1.62), and urinary tract infection (UTI) (aRR=1.34).
- Mycophenolate mofetil use was linked to a reduced risk of candidemia.
Conclusions:
- IFI risk in KTRs is multifactorial, influenced by demographics, comorbidities, and specific fungal pathogens.
- Identifying these risk factors provides a clinical profile to guide the diagnosis and presumptive treatment of IFI in this high-risk population.
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