Bridging Echinocandin with Azole antifungal Therapy On Prevention Of Invasive Candidiasis Post Lung Transplantation

Abstract

Background Invasive Candidiasis (IC) is a significant factor for lung transplant recipient (LTR) mortality, especially in the immediate postoperative phase. Receipt of antifungal prophylaxis has demonstrated lower all-cause mortality. Methods This was a single-center, retrospective cohort study of LTR between August 2017 and August 2020. Included patients were adult LTR with positive Candida cultures pre-operatively (donor or recipient) or within 6 weeks postoperatively. Patients were divided into 2 cohorts—bridged and unbridged. The bridged cohort received micafungin in the postoperative period until therapeutic azole concentrations were achieved or up to 2 weeks, whichever was sooner. The primary outcome was a composite of proven or probable invasive candidiasis. Results A total of 117 patients were included in the study, with 68 in the unbridged cohort and 49 in the bridged cohort. There was more IC in the bridged cohort compared to the unbridged cohort (p = 0.011). Conclusion In combination with an azole antifungal, micafungin did not prevent IC in postoperative LTR with cultures positive for Candida species in this cohort. Larger prospective studies are needed to determine the ideal combination and duration of antifungal prophylaxis.