3
Non-lung Solid Organ Transplant
Î The IDSA recommends prophylactic strategies in solid organ
transplant recipients based on the institutional epidemiology of
infection and assessment of individual risk factors (S-L).
• Prospective trials are lacking to address the need for routine anti-Aspergillus
prophylaxis other than for lung transplant recipients.
• Individual risk factors have been identified in cardiac (pre-transplant colonization,
reoperation, cytomegalovirus [CMV] infection, renal dysfunction, institutional
outbreak), liver (fulminant hepatic failure, reoperation, retransplantation or renal
failure), and other organs with institutional outbreaks or prolonged or high-dose
corticosteroid use. In such patients, the optimal duration of prophylaxis is not
known.
Î Until molecular tools are more widely used in clinical laboratories,
the IDSA recommends that tissue and fluid specimens be submitted
in adequate quantities for simultaneous histopathologic/cytologic and
culture examination. In the case of isolates with atypical growth or
concerns for resistance, species identification by molecular methods
should be employed. (S-H).
Î As research in the area continues, the IDSA recommends that
clinicians choosing to use polymerase chain reaction (PCR) assays
employ them carefully in the management of individual patients on a
case-by-case basis. Clinicians should be aware of the methodologies
and performance characteristics of the specific assay used, and
interpret results accordingly. When PCR assays are used, results
should be considered in conjunction with other diagnostic tests and
the clinical context (S-M).
Galactomannan (GM) and (1→3)-β-D-glucan
Î Serum and bronchoalveolar lavage (BAL) GM is recommended as an
accurate marker for the diagnosis of IA in adult and pediatric patients
when used in certain patient subpopulations (hematologic malignancy,
HSCT) (S-H).
Î GM is not recommended for routine blood screening in patients
receiving mold-active antifungal therapy or prophylaxis but can be
applied to bronchoscopy specimens from those patients (S-H).
Prophylaxis
Diagnosis
