Practice variation in Aspergillus prophylaxis and treatment among lung transplant centers: a national survey
Background Fungal infections remain a substantial cause of mortality in lung transplant (LTx) recipients, yet no comprehensive consensus guidelines have been established for antifungal prophylaxis and treatment of Aspergillus infection in these patients. Methods A cross‐sectional study surveyed the...
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| Veröffentlicht in: | Transplant infectious disease 2015-02, Vol.17 (1), p.14-20 |
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| creator | He, S.Y. Makhzoumi, Z.H. Singer, J.P. Chin-Hong, P.V. Arron, S.T. |
| description | Background
Fungal infections remain a substantial cause of mortality in lung transplant (LTx) recipients, yet no comprehensive consensus guidelines have been established for antifungal prophylaxis and treatment of Aspergillus infection in these patients.
Methods
A cross‐sectional study surveyed the directors from 27 of 64 (45.5%) active LTx centers in the United States to examine clinical practice variations in Aspergillus prophylaxis and treatment of colonization and invasive aspergillosis (IA) in LTx recipients.
Results
Antifungal prophylaxis increased from 52.3% in 2011 to 77.8% in 2013, with the most common agent being inhaled amphotericin B (61.9%), followed by oral voriconazole (51.9%). A total of 74.1% of centers treat Aspergillus airway colonization, with 80.0% of centers using oral voriconazole. All centers treat IA, with 92.6% using oral voriconazole. The duration of Aspergillus prophylaxis and treatment of colonization or IA varied widely across centers from 3 months to >1 year. A total of 51.9% of centers reported internal practice variations in the treatment of IA. Factors guiding treatment decisions included microbiologic culture and sensitivity (74.1%), ease of administration (59.3%), interaction with other medications (55.5%), side effect profile (51.8%), and center guidelines (48.1%). Although 85.2% of LTx centers recommended routine skin cancer screening for LTx recipients, only 44.4% of LTx centers reported having a dedicated transplant dermatologist.
Conclusion
Most active US LTx centers currently employ antifungal prophylaxis and treat Aspergillus colonization and IA, although choice of agent, route of administration, and duration of therapy across and within centers continue to differ substantially. The number of transplant dermatologists available among US LTx centers is limited. Overall, a strong need exists for more comprehensive consensus guidelines to direct antifungal prophylaxis and treatment of Aspergillus infection in LTx recipients. |
| doi_str_mv | 10.1111/tid.12337 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1652418159</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3567312381</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4617-9d4b79a2261c53e3a34bef220e3f981abba74693f8c487dca972d5219ae257ad3</originalsourceid><addsrcrecordid>eNp1kUtv1TAQhS0EoqWw4A8gS2xgkTa2EztmVwp9SAVaVNSlNXEmxcV5YDul99_j3tt2gYQX49H4m6MjH0Jes3KX5bOXXLfLuBDqCdlmQutClJI_XfdNwbkSW-RFjNdlyZSu9HOyxWvJS9GobeLPAtjkLNIbCA6Sm0bqRrofZwxXzvsl0jlM88-Vh1sXKYwdTQEhDTgmCsM0XlG_5JICjHH2kKc2P2GIHyjQcS0InsYl3ODqJXnWg4_46v7eIT8OP18cHBen345ODvZPC1tJpgrdVa3SwLlkthYoQFQt9pyXKHrdMGhbUJXUom9s1ajOgla8qznTgLxW0Ikd8m6jm63_XjAmM7ho0Wd7OC3RMFnzijWs1hl9-w96PS0hW76jKqUaKXWZqfcbyoYpxoC9mYMbIKwMK81dBCZHYNYRZPbNveLSDtg9kg9_noG9DfDHeVz9X8lcnHx6kCw2Gy4mvH3cgPDLSCVUbS6_Hpnzs-_H55cfD80X8RcPSKC_</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1647786690</pqid></control><display><type>article</type><title>Practice variation in Aspergillus prophylaxis and treatment among lung transplant centers: a national survey</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>He, S.Y. ; Makhzoumi, Z.H. ; Singer, J.P. ; Chin-Hong, P.V. ; Arron, S.T.</creator><creatorcontrib>He, S.Y. ; Makhzoumi, Z.H. ; Singer, J.P. ; Chin-Hong, P.V. ; Arron, S.T.</creatorcontrib><description>Background
Fungal infections remain a substantial cause of mortality in lung transplant (LTx) recipients, yet no comprehensive consensus guidelines have been established for antifungal prophylaxis and treatment of Aspergillus infection in these patients.
Methods
A cross‐sectional study surveyed the directors from 27 of 64 (45.5%) active LTx centers in the United States to examine clinical practice variations in Aspergillus prophylaxis and treatment of colonization and invasive aspergillosis (IA) in LTx recipients.
Results
Antifungal prophylaxis increased from 52.3% in 2011 to 77.8% in 2013, with the most common agent being inhaled amphotericin B (61.9%), followed by oral voriconazole (51.9%). A total of 74.1% of centers treat Aspergillus airway colonization, with 80.0% of centers using oral voriconazole. All centers treat IA, with 92.6% using oral voriconazole. The duration of Aspergillus prophylaxis and treatment of colonization or IA varied widely across centers from 3 months to >1 year. A total of 51.9% of centers reported internal practice variations in the treatment of IA. Factors guiding treatment decisions included microbiologic culture and sensitivity (74.1%), ease of administration (59.3%), interaction with other medications (55.5%), side effect profile (51.8%), and center guidelines (48.1%). Although 85.2% of LTx centers recommended routine skin cancer screening for LTx recipients, only 44.4% of LTx centers reported having a dedicated transplant dermatologist.
Conclusion
Most active US LTx centers currently employ antifungal prophylaxis and treat Aspergillus colonization and IA, although choice of agent, route of administration, and duration of therapy across and within centers continue to differ substantially. The number of transplant dermatologists available among US LTx centers is limited. Overall, a strong need exists for more comprehensive consensus guidelines to direct antifungal prophylaxis and treatment of Aspergillus infection in LTx recipients.</description><identifier>ISSN: 1398-2273</identifier><identifier>EISSN: 1399-3062</identifier><identifier>DOI: 10.1111/tid.12337</identifier><identifier>PMID: 25620387</identifier><language>eng</language><publisher>Denmark: Blackwell Publishing Ltd</publisher><subject>Amphotericin B - therapeutic use ; Antifungal Agents - therapeutic use ; antifungal prophylaxis ; Aspergillosis - prevention & control ; Aspergillus - drug effects ; Aspergillus colonization ; Aspergillus prophylaxis ; Cross-Sectional Studies ; Humans ; invasive aspergillosis ; lung transplant recipients ; lung transplantation ; Lung Transplantation - adverse effects ; Pre-Exposure Prophylaxis ; squamous cell carcinoma ; Surveys and Questionnaires ; United States ; Voriconazole - therapeutic use</subject><ispartof>Transplant infectious disease, 2015-02, Vol.17 (1), p.14-20</ispartof><rights>2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd</rights><rights>2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><rights>2015 Wiley Periodicals, Inc</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4617-9d4b79a2261c53e3a34bef220e3f981abba74693f8c487dca972d5219ae257ad3</citedby><cites>FETCH-LOGICAL-c4617-9d4b79a2261c53e3a34bef220e3f981abba74693f8c487dca972d5219ae257ad3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Ftid.12337$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Ftid.12337$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25620387$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>He, S.Y.</creatorcontrib><creatorcontrib>Makhzoumi, Z.H.</creatorcontrib><creatorcontrib>Singer, J.P.</creatorcontrib><creatorcontrib>Chin-Hong, P.V.</creatorcontrib><creatorcontrib>Arron, S.T.</creatorcontrib><title>Practice variation in Aspergillus prophylaxis and treatment among lung transplant centers: a national survey</title><title>Transplant infectious disease</title><addtitle>Transpl Infect Dis</addtitle><description>Background
Fungal infections remain a substantial cause of mortality in lung transplant (LTx) recipients, yet no comprehensive consensus guidelines have been established for antifungal prophylaxis and treatment of Aspergillus infection in these patients.
Methods
A cross‐sectional study surveyed the directors from 27 of 64 (45.5%) active LTx centers in the United States to examine clinical practice variations in Aspergillus prophylaxis and treatment of colonization and invasive aspergillosis (IA) in LTx recipients.
Results
Antifungal prophylaxis increased from 52.3% in 2011 to 77.8% in 2013, with the most common agent being inhaled amphotericin B (61.9%), followed by oral voriconazole (51.9%). A total of 74.1% of centers treat Aspergillus airway colonization, with 80.0% of centers using oral voriconazole. All centers treat IA, with 92.6% using oral voriconazole. The duration of Aspergillus prophylaxis and treatment of colonization or IA varied widely across centers from 3 months to >1 year. A total of 51.9% of centers reported internal practice variations in the treatment of IA. Factors guiding treatment decisions included microbiologic culture and sensitivity (74.1%), ease of administration (59.3%), interaction with other medications (55.5%), side effect profile (51.8%), and center guidelines (48.1%). Although 85.2% of LTx centers recommended routine skin cancer screening for LTx recipients, only 44.4% of LTx centers reported having a dedicated transplant dermatologist.
Conclusion
Most active US LTx centers currently employ antifungal prophylaxis and treat Aspergillus colonization and IA, although choice of agent, route of administration, and duration of therapy across and within centers continue to differ substantially. The number of transplant dermatologists available among US LTx centers is limited. Overall, a strong need exists for more comprehensive consensus guidelines to direct antifungal prophylaxis and treatment of Aspergillus infection in LTx recipients.</description><subject>Amphotericin B - therapeutic use</subject><subject>Antifungal Agents - therapeutic use</subject><subject>antifungal prophylaxis</subject><subject>Aspergillosis - prevention & control</subject><subject>Aspergillus - drug effects</subject><subject>Aspergillus colonization</subject><subject>Aspergillus prophylaxis</subject><subject>Cross-Sectional Studies</subject><subject>Humans</subject><subject>invasive aspergillosis</subject><subject>lung transplant recipients</subject><subject>lung transplantation</subject><subject>Lung Transplantation - adverse effects</subject><subject>Pre-Exposure Prophylaxis</subject><subject>squamous cell carcinoma</subject><subject>Surveys and Questionnaires</subject><subject>United States</subject><subject>Voriconazole - therapeutic use</subject><issn>1398-2273</issn><issn>1399-3062</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kUtv1TAQhS0EoqWw4A8gS2xgkTa2EztmVwp9SAVaVNSlNXEmxcV5YDul99_j3tt2gYQX49H4m6MjH0Jes3KX5bOXXLfLuBDqCdlmQutClJI_XfdNwbkSW-RFjNdlyZSu9HOyxWvJS9GobeLPAtjkLNIbCA6Sm0bqRrofZwxXzvsl0jlM88-Vh1sXKYwdTQEhDTgmCsM0XlG_5JICjHH2kKc2P2GIHyjQcS0InsYl3ODqJXnWg4_46v7eIT8OP18cHBen345ODvZPC1tJpgrdVa3SwLlkthYoQFQt9pyXKHrdMGhbUJXUom9s1ajOgla8qznTgLxW0Ikd8m6jm63_XjAmM7ho0Wd7OC3RMFnzijWs1hl9-w96PS0hW76jKqUaKXWZqfcbyoYpxoC9mYMbIKwMK81dBCZHYNYRZPbNveLSDtg9kg9_noG9DfDHeVz9X8lcnHx6kCw2Gy4mvH3cgPDLSCVUbS6_Hpnzs-_H55cfD80X8RcPSKC_</recordid><startdate>201502</startdate><enddate>201502</enddate><creator>He, S.Y.</creator><creator>Makhzoumi, Z.H.</creator><creator>Singer, J.P.</creator><creator>Chin-Hong, P.V.</creator><creator>Arron, S.T.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7U9</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>201502</creationdate><title>Practice variation in Aspergillus prophylaxis and treatment among lung transplant centers: a national survey</title><author>He, S.Y. ; Makhzoumi, Z.H. ; Singer, J.P. ; Chin-Hong, P.V. ; Arron, S.T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4617-9d4b79a2261c53e3a34bef220e3f981abba74693f8c487dca972d5219ae257ad3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Amphotericin B - therapeutic use</topic><topic>Antifungal Agents - therapeutic use</topic><topic>antifungal prophylaxis</topic><topic>Aspergillosis - prevention & control</topic><topic>Aspergillus - drug effects</topic><topic>Aspergillus colonization</topic><topic>Aspergillus prophylaxis</topic><topic>Cross-Sectional Studies</topic><topic>Humans</topic><topic>invasive aspergillosis</topic><topic>lung transplant recipients</topic><topic>lung transplantation</topic><topic>Lung Transplantation - adverse effects</topic><topic>Pre-Exposure Prophylaxis</topic><topic>squamous cell carcinoma</topic><topic>Surveys and Questionnaires</topic><topic>United States</topic><topic>Voriconazole - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>He, S.Y.</creatorcontrib><creatorcontrib>Makhzoumi, Z.H.</creatorcontrib><creatorcontrib>Singer, J.P.</creatorcontrib><creatorcontrib>Chin-Hong, P.V.</creatorcontrib><creatorcontrib>Arron, S.T.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Transplant infectious disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>He, S.Y.</au><au>Makhzoumi, Z.H.</au><au>Singer, J.P.</au><au>Chin-Hong, P.V.</au><au>Arron, S.T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Practice variation in Aspergillus prophylaxis and treatment among lung transplant centers: a national survey</atitle><jtitle>Transplant infectious disease</jtitle><addtitle>Transpl Infect Dis</addtitle><date>2015-02</date><risdate>2015</risdate><volume>17</volume><issue>1</issue><spage>14</spage><epage>20</epage><pages>14-20</pages><issn>1398-2273</issn><eissn>1399-3062</eissn><abstract>Background
Fungal infections remain a substantial cause of mortality in lung transplant (LTx) recipients, yet no comprehensive consensus guidelines have been established for antifungal prophylaxis and treatment of Aspergillus infection in these patients.
Methods
A cross‐sectional study surveyed the directors from 27 of 64 (45.5%) active LTx centers in the United States to examine clinical practice variations in Aspergillus prophylaxis and treatment of colonization and invasive aspergillosis (IA) in LTx recipients.
Results
Antifungal prophylaxis increased from 52.3% in 2011 to 77.8% in 2013, with the most common agent being inhaled amphotericin B (61.9%), followed by oral voriconazole (51.9%). A total of 74.1% of centers treat Aspergillus airway colonization, with 80.0% of centers using oral voriconazole. All centers treat IA, with 92.6% using oral voriconazole. The duration of Aspergillus prophylaxis and treatment of colonization or IA varied widely across centers from 3 months to >1 year. A total of 51.9% of centers reported internal practice variations in the treatment of IA. Factors guiding treatment decisions included microbiologic culture and sensitivity (74.1%), ease of administration (59.3%), interaction with other medications (55.5%), side effect profile (51.8%), and center guidelines (48.1%). Although 85.2% of LTx centers recommended routine skin cancer screening for LTx recipients, only 44.4% of LTx centers reported having a dedicated transplant dermatologist.
Conclusion
Most active US LTx centers currently employ antifungal prophylaxis and treat Aspergillus colonization and IA, although choice of agent, route of administration, and duration of therapy across and within centers continue to differ substantially. The number of transplant dermatologists available among US LTx centers is limited. Overall, a strong need exists for more comprehensive consensus guidelines to direct antifungal prophylaxis and treatment of Aspergillus infection in LTx recipients.</abstract><cop>Denmark</cop><pub>Blackwell Publishing Ltd</pub><pmid>25620387</pmid><doi>10.1111/tid.12337</doi><tpages>7</tpages></addata></record> |
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| ispartof | Transplant infectious disease, 2015-02, Vol.17 (1), p.14-20 |
| issn | 1398-2273 1399-3062 |
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| source | MEDLINE; Access via Wiley Online Library |
| subjects | Amphotericin B - therapeutic use Antifungal Agents - therapeutic use antifungal prophylaxis Aspergillosis - prevention & control Aspergillus - drug effects Aspergillus colonization Aspergillus prophylaxis Cross-Sectional Studies Humans invasive aspergillosis lung transplant recipients lung transplantation Lung Transplantation - adverse effects Pre-Exposure Prophylaxis squamous cell carcinoma Surveys and Questionnaires United States Voriconazole - therapeutic use |
| title | Practice variation in Aspergillus prophylaxis and treatment among lung transplant centers: a national survey |
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