Background: The prevalence and outcomes of COVID-19-associated invasive fungal infections (CAIFIs) in solid organ transplant recipients (SOTRs) remain poorly understood.
Methods: A retrospective cohort study of SOTRs with COVID-19 admitted to 5 hospitals within Johns Hopkins Medicine was performed between March 2020 and March 2022. Cox regression multilevel mixed-effects ordinal logistic regression was used.
Results: In the cohort of 276 SOTRs, 22 (8%) developed IFIs. The prevalence of CAIFIs was highest in lung transplant recipients (20%), followed by recipients of heart (2/28; 7.1%), liver (3/46; 6.5%), and kidney (7/149; 4.7%) transplants. In the overall cohort, only 42 of 276 SOTRs (15.2%) required mechanical ventilation; these included 11 of 22 SOTRs (50%) of the CAIFI group and 31 of 254 SOTRs (12.2%) of the no-CAIFI group. Compared with those without IFIs, SOTs with IFIs had worse outcomes and required more advanced life support (high-flow oxygen, vasopressor, and dialysis). SOTRs with CAIFIs had higher 1-y death-censored allograft failure (hazard ratio 1.6 5.1 16.4 , P = 0.006) and 1-y mortality adjusting for oxygen requirement (adjusted hazard ratio 1.1 2.4 5.1 , P < 0.001), compared with SOTRs without CAIFIs.
Conclusions: The prevalence of CAIFIs in inpatient SOTRs with COVID-19 is substantial. Clinicians should be alert to the possibility of CAIFIs in SOTRs with COVID-19, particularly those requiring supplemental oxygen, regardless of their intubation status.
Competing Interests: N.P. received consulting/advisory board income from Shionogi Inc, Pulmocide Ltd, ClearView HealthCare Partners, and Alcimed; and study grant support from CareDx, IMMY Diagnostics, and Merck. R.A. received grant/research support from Aicuris, Astellas, Chimerix, Merck, Oxford Immunotec, Qiagen, Regeneron, and Takeda/Shire. C.M.D. reported serving on the grant review committee for Gilead Sciences. S.X.Z. received research funds from IMMY Diagnostics and Vela Diagnostics. D.L.S. received honoraria from Sanofi (speaking), Novartis (speaking, consulting), Veloxis (consulting), Mallinckrodt (consulting), Jazz Pharmaceuticals (consulting), CSL Behring (consulting), Thermo Fisher Scientific (consulting), CareDx (speaking, consulting), Transmedics (consulting), Kamada (consulting), MediGO (consulting), Regeneron (consulting), AstraZeneca (speaking, consulting), Takeda (consulting), and Bridge to Life (speaking). K.A.M. received consulting/advisory board income from Cidara and Merck and equity and salary from Sfunga Therapeutics and Pearl Diagnostics. The other authors declare no conflicts of interest.
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