Fluconazole versus micafungin for initial antifungal prophylaxis against Candida in pancreas transplant recipients: A comparative study of two consecutive periods

• Published in: Mycoses Vol. 65; no. 5; pp. 517 - 525
• Main Authors: López‐Medrano, Francisco, Muñoz de la Espada, María, Pérez‐Jacoiste Asín, María Asunción, Fernández‐Ruiz, Mario, Herrero‐Martínez, Juan María, Alonso‐Carrillo, Jesús, San Juan, Rafael, Rodríguez‐Goncer, Isabel, Andrés, Amado, González, Esther, Manrique, Alejandro, Justo, Iago, Marcacuzco, Alberto, Loinaz, Carmelo, Jiménez, Carlos, Lumbreras, Carlos, Aguado, José María
• Format: Journal Article
• Language: English
• Published: Germany Wiley Subscription Services, Inc 01-05-2022
• Subjects: Adult; Antifungal Agents - therapeutic use; antifungal prophylaxis; Candida; Candidiasis; Candidiasis, Invasive - drug therapy; Disease prevention; equinocandin; Female; Fluconazole; Fluconazole - therapeutic use; Humans; Infections; Insulin; Ischemia; Kidney transplantation; Male; Micafungin; Middle Aged; Pancreas; Pancreas transplantation; Pancreas Transplantation - adverse effects; Pancreas transplants; Prophylaxis; Retrospective Studies; Surgical site infections; Transplant Recipients; equinocandin; fluconazole; pancreas transplantation; antifungal prophylaxis; micafungin; Candida
• ISSN: 0933-7407; 1439-0507
• DOI: 10.1111/myc.13436

Background
Invasive fungal infection, particularly intraabdominal candidiasis, exerts a negative impact on the outcome of pancreas transplant recipients (PTRs). Optimal antifungal prophylaxis in this context remains unclear.
Methods
We performed a single‐centre retrospective study to compare the incidence of invasive candidiasis during the first 6 post‐transplant months in a cohort of 218 PTRs over two periods in which different agents for antifungal prophylaxis were used: fluconazole (Fluco‐Px) from March 1995 to June 2012, and micafungin followed by fluconazole (Mica‐Px) from July 2012 to December 2018.
Results
A total of 152 and 66 PTRs received Fluco‐Px and Mica‐Px. Mean age was 39.7 ± 7.8 years, 56.4% (123/218) were males, and 85.3% (186/218) underwent simultaneous pancreas–kidney transplantation. Invasive candidiasis occurred in 21.7% (33/152) of PTRs under Fluco‐Px compared to 24.2% (16/66) of those under Mica‐Px (p‐value = .681). Median time from transplantation to infection was 8 days (interquartile range [IQR]: 6–16) under Fluco‐Px versus 6.5 (IQR: 3.3–15.8) under Mica‐Px (p‐value = .623). Non‐albicans Candida species comprised 27.5% (11/40) and 25.0% (4/16) of episodes under Fluco‐Px and Mica‐Px respectively (p‐value = .849). Surgical site infection was the most common form in both groups (82.5% [33/40] and 87.5% [14/16]; p‐value = .954). Multivariable analysis identified cold ischaemia time of the pancreas and kidney grafts, surgical reintervention and insulin requirement after transplantation as risks factor for invasive candidiasis.
Conclusion
This retrospective study did not reveal a significant benefit from the initial use of micafungin‐based antifungal prophylaxis over fluconazole among PTRs in terms of invasive candidiasis.