Fluconazole versus micafungin for initial antifungal prophylaxis against Candida in pancreas transplant recipients: A comparative study of two consecutive periods. Issue 5 (15th March 2022)

• Record Type: Journal Article
• Authors: López‐Medrano, Francisco; Muñoz de la Espada, María; Pérez‐Jacoiste Asín, María Asunción; Fernández‐Ruiz, Mario; Herrero‐Martínez, Juan María; Alonso‐Carrillo, Jesús; San Juan, Rafael; Rodríguez‐Goncer, Isabel; Andrés, Amado; González, Esther; Manrique, Alejandro; Justo, Iago; Marcacuzco, Alberto; Loinaz, Carmelo; Jiménez, Carlos; Lumbreras, Carlos; Aguado, José María
• Is Part Of: Mycoses. Volume 65:Issue 5(2022)
• Page Start: 517
• Page End: 525
• Publication Date: 2022-03-15
• Subjects: antifungal prophylaxis -- Candida -- equinocandin -- fluconazole -- micafungin -- pancreas transplantation; Pathogenic fungi -- Periodicals; Medical mycology -- Periodicals; 616.969
• DOI: 10.1111/myc.13436
• Languages: English
• ISSNs: 0933-7407

Abstract

Abstract: Background: Invasive fungal infection, particularly intraabdominal candidiasis, exerts a negative impact on the outcome of pancreas transplant recipients (PTRs). Optimal antifungal prophylaxis in this context remains unclear. Methods: We performed a single‐centre retrospective study to compare the incidence of invasive candidiasis during the first 6 post‐transplant months in a cohort of 218 PTRs over two periods in which different agents for antifungal prophylaxis were used: fluconazole (Fluco‐Px) from March 1995 to June 2012, and micafungin followed by fluconazole (Mica‐Px) from July 2012 to December 2018. Results: A total of 152 and 66 PTRs received Fluco‐Px and Mica‐Px. Mean age was 39.7 ± 7.8 years, 56.4% (123/218) were males, and 85.3% (186/218) underwent simultaneous pancreas–kidney transplantation. Invasive candidiasis occurred in 21.7% (33/152) of PTRs under Fluco‐Px compared to 24.2% (16/66) of those under Mica‐Px ( p ‐value = .681). Median time from transplantation to infection was 8 days (interquartile range [IQR]: 6–16) under Fluco‐Px versus 6.5 (IQR: 3.3–15.8) under Mica‐Px ( p ‐value = .623). Non‐ albicans Candida species comprised 27.5% (11/40) and 25.0% (4/16) of episodes under Fluco‐Px and Mica‐Px respectively ( p ‐value = .849). Surgical site infection was the most common form in both groups (82.5% [33/40] and 87.5% [14/16]; p ‐value = .954). Multivariable analysis identified cold ischaemia time of the pancreas and kidney grafts, surgical reintervention and insulin requirement after transplantation as risks factor for invasive candidiasis. Conclusion: This retrospective study did not reveal a significant benefit from the initial use of micafungin‐based antifungal prophylaxis over fluconazole among PTRs in terms of invasive candidiasis.