Objectives: Patients with severe liver disease and multiorgan failure are at high risk of invasive fungal infections (IFI). Anidulafungin (ANI) is an echinocandin not requiring dose adjustment in hepatic and renal failure, indicated for the treatment of invasive candidiasis. This study analyzed the effectiveness and safety of ANI treatment of IFI in patients with progressive liver disease and following liver transplantation complicated by graft dysfunction who were admitted to a tertiary referral liver centre; the incidence of multi organ failure in the study population was high. Method: Retrospective review of case notes and database of 50 consecutive patients with IFI and treated with ANI between July 2009 and March 2011. The Primary Endpoint was to describe the effectiveness and safety of ANI in this group of patients at King’s College Hospital liver centre. Results: There were 72% proven cases of IFI and 28% probable IFI cases. Median age was 54.3 years (range 19.6-75.9) and 60% male. The majority of enrolled patients were liver transplant recipients (n = 22), followed by acute liver failure (n = 6), and hepatopancreaticobiliary disease (n = 15). Of 44% of patients presented with decompensated chronic liver disease. Most of infections were due to Candida and predominant species causing IFI were Candida albicans (34%) and C. glabrata (34%). Other markers of disease were: concomitant bacterial infection in 96% of patients, 74% underwent major abdominal surgery, renal failure 62%, upper GI bleeding 42%, renal replacement therapy 40%, diabetes 36% and prior Candida colonization 42%. 76% of patients received antifungal prophylaxis within 30 days prior to the start of ANI. A favourable outcome was seen in 65% patients. Four patients had breakthrough infections due to C. parapsilosis (2), and C. glabrata (2). There was one case of persistent C. glabrata infection despite ANI therapy. Favourable clinical response was observed in 30 out of 45 evaluated patients (71.1%). 54% of patients had abnormal liver function tests (LFTs) at start of ANI and 30% at the end of ANI therapy. Rises in LFTs were mainly due to the underlying disease. 38% died because of liver disease progression and multiorgan failure and none of these deaths were attributed to fungal infection, or medication related. Conclusion: In this highly selective group of patients, ANI for the treatment of IFI appeared to be effective, safe and well tolerated. A favourable outcome was observed in 65% of patients.
Full conference title:
22nd European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 22nd (2012)