210.11: COVID-19 Associated Fungal Co-infections in Solid Organ Transplant Recipients: a Single Center Case Series.

Abstract

Introduction: During the ongoing Coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of co-infections with viral, bacterial and fungal pathogens. Two specific COVID-19-related fungal infections have been identified – COVID-19 associated pulmonary aspergillosis (CAPA) and COVID-19 associated mucormycosis (CAM), with limited information available about their incidence and occurrence in solid organ transplant recipients (SOTRs). We describe our experience with COVID-19 associated fungal co-infections (CFIs) in SOTRs with COVID-19. Methods: This was a single center retrospective study at a large volume transplant center in South Florida, USA. We included adult SOTRs (≥18 years) diagnosed with COVID-19 between March 1st 2020 and January 31st 2022, with a subsequent diagnosis of CFI. We collected information related to demographics, comorbidities, COVID-19 diagnosis and therapeutics, and CFI diagnostics and management. We performed descriptive statistical analysis on the data obtained. Results: We identified 612 SOTRs with COVID-19, of which 23 (3.8%) were diagnosed with CFIs. The patients were predominantly male (17/23, 73.9%), with median age of 59 years (range 43-79) (Table 1). Twenty (86.9%) were kidney transplant recipients. Majority of SOTRs had lymphopenia (18/23, 78.3%) with elevated inflammatory markers at time of COVID-19 diagnosis. They received most commonly remdesivir and corticosteroids for COVID-19, with 22 (95.6%) needing intensive care unit admission and 19 (82.6%) needing continuous renal replacement therapy. CFIs were diagnosed at median 21 days (range, 3-161) after initial COVID-19 diagnosis. Probable CAPA was diagnosed in most patients (16/23, 69.6%), with CAM noted in 1 patient (Table 2). 34.8% (8/23) had specific fungal species identified, with elevated fungal markers noted in 95.6% (22/23). Concurrent or prior cytomegalovirus DNAemia was noted in 26.1% (6/23). Patients were followed for median 70 days (range, 19-572), with median hospitalization duration 56 days (range, 7-204). Mortality was noted in 73.9% (17/23). Conclusion: Fungal co-infections were noted in a small proportion of our SOTRs, with poor outcomes. Transplant physicians should have a high suspicion for early diagnosis and treatment of CFI. Further studies are needed to determine predictors for CFI and role for anti-fungal prophylaxis.