Invasive Fungal Infections in Inpatient Solid Organ Transplant Recipients With COVID-19: A Multicenter Retrospective...

Area of Science:

• Infectious Diseases
• Transplant Medicine
• Critical Care Medicine

Background:

• COVID-19-associated invasive fungal infections (CAIFIs) in solid organ transplant recipients (SOTRs) are not well understood.
• Solid organ transplant recipients are at increased risk for infections due to immunosuppression.

Purpose of the Study:

• To determine the prevalence and outcomes of CAIFIs in SOTRs with COVID-19.
• To identify risk factors and clinical characteristics associated with CAIFIs in this population.

Main Methods:

• A retrospective cohort study was conducted involving SOTRs with COVID-19 admitted to Johns Hopkins Medicine between March 2020 and March 2022.
• Cox regression multilevel mixed-effects ordinal logistic regression was used to analyze outcomes.

Main Results:

• Of 276 SOTRs, 22 (8%) developed IFIs. Lung transplant recipients had the highest prevalence (20%).
• SOTRs with CAIFIs required more advanced life support, including mechanical ventilation (50% vs 12.2%).
• CAIFIs were associated with significantly higher 1-year death-censored allograft failure (HR 16.4) and 1-year mortality (aHR 5.1).

Conclusions:

• The prevalence of CAIFIs in hospitalized SOTRs with COVID-19 is substantial.
• Clinicians should consider CAIFIs in SOTRs with COVID-19, especially those requiring supplemental oxygen, irrespective of intubation status.