Bridging Echinocandin With Azole Antifungal Therapy on Prevention of Invasive Candidiasis Post-Lung Transplantation

Background: Invasive candidiasis (IC) is a significant factor for lung transplant recipient (LTR) mortality, especially in the immediate postoperative phase. Receipt of antifungal prophylaxis has demonstrated lower all-cause mortality.

Methods: This was a single-center, retrospective cohort study of LTRs between August 2017 and August 2020. Included patients were adult LTRs with positive Candida cultures preoperatively (donor or recipient) or within 6 weeks postoperatively. Patients were divided into 2 cohorts-bridged and unbridged. The bridged cohort received micafungin in the postoperative period until therapeutic azole concentrations were achieved or up to 2 weeks, whichever was sooner. The primary outcome was a composite of proven or probable invasive candidiasis.

Results: A total of 117 patients were included in the study, with 68 in the unbridged cohort and 49 in the bridged cohort. There were more cases of IC in the bridged cohort than in the unbridged cohort (P = .011).

Conclusions: In combination with an azole antifungal, micafungin did not prevent IC in postoperative LTRs with cultures positive for Candida species in this cohort. Larger prospective studies are needed to determine the ideal combination and duration of antifungal prophylaxis.