Zygomycosis in Solid Organ Transplant Recipients: A Prospective, Matched Case-Control Study to Assess Risks for Disease and Outcome

作者：Singh Nina^*; Aguado Jose M; Bonatti Hugo; Forrest Graeme; Gupta Krishan L; Safdar Nasia; John George T; Pursell Kenneth J; Munoz Patricia; Patel Robin; Fortun Jesus; Martin Davila Pilar; Philippe Bruno; Philit Francois; Tabah Alexis; Terzi Nicolas; Chatelet Valerie; Kusne Shimon; Clark Nina; Blumberg Emily; Blanes Julia Marino; Humar Abhi; Houston Sally; Lass Floerl Cornelia; Johnson Leonard; Dubberke Erik R; Barron Michelle A; Lortholary Olivier

来源：Journal of Infectious Diseases, 2009, 200(6): 1002-1011.

DOI：10.1086/605445

Background. Clinical characteristics, risks, and outcomes in solid organ transplant (SOT) recipients with zygomycosis in the era of modern immunosuppressive and newer antifungal agent use have not been defined.
Methods. In a matched case-controlled study, SOT recipients with zygomycosis were prospectively studied. The primary outcome measure was success (complete or partial response) at 90 days.
Results. Renal failure (odds ratio [OR], 3.17; P = .010), diabetes mellitus (OR, 8.11; P<.001), and prior voriconazole and/or caspofungin use (OR, 4.41; P = .033) were associated with a higher risk of zygomycosis, whereas tacrolimus (OR, 0.23; P = .002) was associated with a lower risk of zygomycosis. Liver transplant recipients were more likely to have disseminated disease (OR, 5.48; P = .021) and developed zygomycosis earlier after transplantation than did other SOT recipients (median, 0.8 vs 5.7 months; P<.001). Overall the treatment success rate was 60%. Renal failure (OR, 11.3; P = 0.23) and disseminated disease (OR, 14.6; P = .027) were independently predictive of treatment failure, whereas surgical resection was associated with treatment success (OR, 33.3; P = .003). The success rate with liposomal amphotericin B was 4-fold higher even when controlling for the afore-mentioned variables.
Conclusions. The risks identified for zygomycosis and for disseminated disease, including those that were previously unrecognized, have implications for further elucidating the biologic basis and for optimizing outcomes in SOT recipients with zygomycosis

• 出版日期2009-9-15
• 单位河北医科大学