Italian Guidelines for Diagnosis, Prevention, and Treatment of Invasive Fungal Infections in Solid Organ Transplant Recipients (original) (raw)

Abstract

Use of various induction regimens, of novel immunosuppressive agents, and of newer prophylactic strategies continues to change the pattern of infections among solid organ transplant (SOT) recipients. Although invasive fungal infections (IFIs) occur at a lower incidence than bacterial and viral infections in this population, they remain a major cause of morbidity and mortality worldwide. In March 2008, a panel of Italian experts on fungal infections and organ transplantation convened in Castel Gandolfo (Rome) to develop consensus guidelines for the diagnosis, prevention, and treatment of IFIs among SOT recipients. We discussed the definitions, microbiological and radiological diagnoses, prophylaxis, empirical treatment, and therapy of established disease. Throughout the consensus document, recommendations as clinical guidelines were rated according to the standard scoring system of the Infectious Diseases Society of America and the United Stated Public Health Service. U SE of induction regimens, of novel immunosuppressive agents, and of newer prophylactic strategies continues to change the pattern of infections among solid organ transplant (SOT) recipients. 1,2 Despite showing lower incidence than bacterial and viral infections, invasive fungal infections (IFIs) remain a major cause of morbidity and mortality in this population worldwide. 3 Fungal infections among the various types of solid organ transplantation show different incidences, underlying pathogenic mechanisms, and modes of clinical presentation. Two genera, Aspergillus and Candida, are responsible for the vast majority of fungal infections in SOT recipients. They account for more than 80% of IFIs, which typically occur within the first month after transplantation. 1,2 Recent epidemiological studies have suggested the emergence of resistant strains of Candida as well as mycelial fungi other than Aspergillus to produce infections in these patients. 4,5 Guidelines for the prevention and treatment have been published by the American Society of Transplantation (AST) and more recently by the Infectious Diseases Society of America (IDSA). 6-11 However, the management of fungal infections varies widely among transplantation centers. Large multicenter randomized controlled trials have not yet been performed to evaluate risk factors, diagnoses, prophylaxis, and treatment strategies for fungal infections among SOT recipients. Consequently, there is no uniform consensus regarding these facets. Clinical practice has evolved mainly From the Department of Clinical Medicine (P.A

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