Risk Factors Associated With Invasive Fungal Infections in Kidney Transplant Patients.
BACKGROUND
Kidney transplant recipients are at increased risk for developing invasive fungal infections (IFI). We queried the United States Renal Data System (USRDS) for risk factors for IFI in these patients.


METHODS
Patients who underwent a kidney transplant between 2005 and 2008 were queried for an IFI diagnosis using ICD-9 codes. An IFI was defined as at least one documented diagnosis from one of the following: (1) Candida (candidemia); (2) Histoplasmosis; (3) Aspergillosis; (4) Cryptococcosis; (5) "Other" mycoses. Potential risk factors included demographics, certain comorbidities and immunosuppressive medications. To examine the relative risk (RR), simple bivariate models were used, followed by a comprehensive full model to estimate the adjusted RR (aRR).


RESULTS
Of 57,188 kidney transplant patients, 1,218 had 1,343 IFI diagnoses, with a median time to infection of 495 days. "Other" mycoses accounted for the most IFI diagnoses (37%), followed by aspergillosis (22%). The risk for any IFI was increased with age ≥65 years. Diabetes (aRR = 1.71), bacterial pneumonia (aRR = 1.62) and UTI (aRR = 1.34) were the top 3 clinical risk factors for infection. Each of the IFI groups was also associated with individual risk factors. Therapy with mycophenolate mofetil was associated with a decreased risk of candidemia.


CONCLUSIONS
Risk factors for IFI in renal transplant patients include demographic, medication-associated and clinical data, as well as organism-specific factors. These results offer an extensive clinical profile of risk for IFI, and may thus help inform the diagnosis and presumptive therapy of invasive fungal infections in renal transplant recipients.
['Leitheiser|Sara|S|', 'Harner|Andrew|A|', 'Waller|Jennifer L|JL|', 'Turrentine|Jake|J|', 'Baer|Stephanie|S|', 'Kheda|Mufaddal|M|', 'Nahman|N Stanley|NS|', 'Colombo|Rhonda E|RE|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D001228:Aspergillosis D005260:Female D006801:Humans D007166:Immunosuppressive Agents D000072742:Invasive Fungal Infections D016030:Kidney Transplantation D008297:Male D008875:Middle Aged D008954:Models, Biological D012307:Risk Factors
Risk factors Invasive fungal infection Infections Kidney transplantation