1101 - Pulmonary Aspergillosis Complicating Non-Influenza Respiratory Virus Infections Among Solid Organ Transplant Recipients

Background: Invasive pulmonary aspergillosis (IPA) complicating influenza (flu) has been increasingly recognized. We have shown that IPA occurred in 22% of solid organ transplant (SOT) patients (pts) with flu. Associations between IPA and non-flu respiratory infections (non-flu-RVI) in SOT are unknown.

Methods: Retrospective review of consecutive pts transplanted from Jan 15, 2010-Dec 19, 2017. Pts who died within 100 days of SOT were excluded. Non-flu-RVI IFI was defined according to revised EORTC/MSG criteria. IFI had to occur within 100 days of non-flu-RVI. Colonization (COL) was defined as recovery of mold from airways in absence of IFI.

Results: 3,077 pts were included. 256 cases of non-flu-RVI were identified in lung (28%), multi-organ (16%), heart (6%), liver (1.3%) and kidney (1%) SOT pts. Parainfluenza (PIV) was most common (44%), followed by Respiratory Syncytial Virus (RSV, 60%) and Adenovirus (ADV, 15%). Median time to non-flu-RVI infections was 18.1 mos. 24% of pts with non-flu-RVI had lower tract disease. ADV was associated with longer hospital stay (median 14.5 days) than PIV (6.5 days) or RSV (6 days) (p=0.004). 59% of pts with non-flu-RVI required admission, and 64% received augmented steroids. Aspergillus was recovered from respiratory culture in 17% of non-flu-RVI pts. No other fungi were identified. Median time from non-flu-RVI to + culture was 29 days (Figure). 23% of pts with + culture had proven (7) or probable IPA (3), respectively; 77% had COL. 8% (3/37), 5% (6/114) and 7% (1/15) of pts with ADV, PIV, RSV infections developed IPA, respectively. 36% of pts were treated with a mold-active azole after + culture. Multivariate analysis identified lung transplant (p=0.02), PIV infection (p=0.02) and cumulative steroid dose in preceding 7 days (p=0.015) as independent risk factors for Aspergillus culture positivity. Cumulative steroid dose in preceding 7 days was an independent risk factor for IPA (p=0.03).Cumulative incidence of Aspergillus infections within 100 days of non-flu RVI


Conclusion: IPA and COL occurred in 4% and 13% of non-flu-RVI in SOT recipients. Routine antifungal prophylaxis is not recommended for SOT pts with non-flu-RVI. The value of prophylaxis at time of PIV infection for lung transplant pts with recent steroid augmentation should be studied.