• Efficacy of Fluconazole Prophylaxis of Coccidiodiomycosis in Post-Transplant Patients in an Endemic Area

      Cosgrove, Richard; Nix, David; Alver, Kathryn; Simacek, Anne; Cosgrove, Richard; Nix, David; College of Pharmacy, The University of Arizona (The University of Arizona., 2015)
      Objectives: To assess the efficacy of fluconazole prophylaxis in the prevention of coccidioidomycosis in the post-heart transplant patient and to identify risk factors for coccidioidomycosis infection. Methods: Heart transplant patients with ICD-9 code V42.1 from October 2001 to October 2013, were selected and electronic medical records were retrospectively reviewed for coccidioidomycosis history, Coccidiodes serologies, reason for transplantation, immunosuppressive drug therapy regimens, rejection treatment course, fluconazole dose, and demographics. Negative Coccidiodes serology results post transplantation relative to negative Coccidiodes serology results prior to transplantation will be determined using a Chi Square test. Risk factors for disease contraction will be analyzed using multivariate logistic regression. Results: Between October 2001 and October 2013, 244 patients received a heart transplant at this institution. Fourteen (5.7%) heart transplant recipients with a negative Coccidiodes serology pre-transplantation had a positive Coccidiodes serology post-transplantation. Nine (64.2%) of those recipients received antifungal prophylaxis (p=0.16). Risk factors for developing a positive Coccidiodes serology included using tacrolimus (p=0.05) and non-ischemic cardiomyopathy (p=0.04). Conclusions: Antifungal prophylaxis does not reduce the risk of developing a positive Coccidiodes serology after heart transplantation. Risk factors for developing a positive Coccidiodes serology include the use of tacrolimus and having non-ischemic cardiomyopathy prior to transplant.