Retrospective, multicentre, pharmaco-epidemiological study of the administration of liposomal amphotericin B in patients admitted to intensive care units
Abstract number: P1032
Alvarez-Lerma F., Mariscal F., Quintana E., Rialp G., Díaz J., Pérez M., Alvarez B., Ausín I.
Objective: To analyse the indications and posology of liposomal amphotericin B (L-AMB) in patients admitted to intensive care units (ICUs).
Methods: Retrospective, multicentre and observational study of patients admitted to ICUs and treated with L-AMB for any reason in 2006. Invasive fungal infections (IFIs) were classified as proven, probable or possible. Treatment indications were classified as first line or as rescue treatment.
Results: 179 patients were included and 30 ICUs participated. Mean APACHE II score was 20.9 (SD:7.9), mean length of ICU stay was 28.6 (SD: 24.0) days and intra-ICU mortality rate was 43.4%. Most common pathologies were medical pathology (45.3%) and surgery (34.1%) and 68.2% of the patients had severe sepsis or septic shock. Invasive fungal infections were proven, probable and possible in 43.6%, 15.6%, and 25.1% of cases, respectively and not classified in the remaining 15.7%. Aetiology: Candida albicans (38.0%), Candida non-albicans (15.1%), Aspergillus spp. (7.3%), two or more Candida spp. (12.3%). Mean duration of treatment was 15 days at a mean dose of 3.7 mg/kg/day. In 47.5% of the cases L-AMB was used as rescue treatment after fluconazole (40 cases) or caspofungin (30 cases) and as first line in the other 52.5% of the cases. Clinical response in evaluable patients (n = 354) was classified as satisfactory in 53.9% (n = 33) of the cases (72.6% in proven infection) and microbiological eradication in evaluable patients (n = 308) was achieved in 67.6% (n = 33) of the cases. Adverse events were detected on 51 patients but were classified as serious in only 4 (2.2%) patients. Severe renal failure requiring a change in the antifungal treatment was detected in only one case. There was no change in the mean creatinine value at the end of treatment in the patients treated with L-AMB, despite the fact that 109 (60.9%) were receiving nephrotoxic drugs concomitantly.
Conclusions: L-AMB was used predominantly in critically ill patients (haemodynamically unstable), both as first line and as rescue treatment above all for proven infections. In this group of patients satisfactory clinical response was very high. L-AMB was well tolerated, with little alteration of renal function even in patients taking concomitant nephrotoxic drugs.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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