Objective: Invasive fungal infections (IFI) are a frequent life-threatening complication in high risk patients hospitalized in ICUs. The objective of this study was to analyse the efficacy and safety of liposomal amphotericin B (L-AmB) administered to ICU patients with confirmed IFI. Methods: Retrospective, multicenter and observational study of patients admitted to ICUs with confirmed fungal infection and treated with L-AMB. Results: Seventy-eight patients were included, 57.1% were male and median age was 56 years. Mean time in ICU was 46.4 (SD: 50.4) days and mortality rate in ICU was 42.7%. Mean APACHE II score was 21.3 (SD: 8.0) and severe sepsis or septic shock was 65.4%. Most common pathologies were medical (4.3%) and surgery pathology (42.3%). Most common proven IFIs were Candida albicans (56.4%), Candida glabrata (14.1%), Candida parapsilosis (11.5%) and Aspergillus spp (7.7%). Mean duration of treatment was 16.5 days and mean dose was 3.7 mg/kg/day. Previous antifungal treatment was administered to 56.4% of patients, mainly fluconazole (29.5%) and Caspofungin (21.8%). Most common reasons L-AmB was initiated were: non-stable disease (48.7%), infection localization (38.5%) and L-AmB spectrum (34.6%). Satisfactory clinical response (Complete and partial response) was achieved in 68% (95% CI: 57.6, 78.3) of the patients and microbiological response (negative culture) in 61.5% (95% CI: 50.7, 72.3) of the patients. Within evaluable patients these results were: 72.6% (95% CI: 62.4, 82.8) and 76.2 (95% CI: 65.7, 86.7). 34 related AEs were reported, but only 2 were reported as serious: a case of hypokalaemia and a case of renal failure requiring a change in the antifungal treatment. There was no change in the global mean creatinine value at the end of treatment in the patients treated with L-AMB, despite the fact that 52.6% were receiving nephrotoxic drugs concomitantly. Conclusion: L-AmB was used in critically ill patients (haemodynamically unstable) with confirmed IFI, including a high proportion who had received previous therapy for IFI. Satisfactory clinical and microbiological response in evaluable patients was high. L-AmB was well tolerated with little alteration of renal function even in patients taking concomitant nephrotoxic drugs. L-Amb can be considered an effective and safe option in confirmed IFIs in critically patients.
Full conference title:
19th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 19th (2009)