Influence of liposomal amphotericin B on the renal function of intensive care patients with elevated serum creatinine levels. A multicentre, retrospective, observational case collection study
Abstract number: P1033
Alvarez-Lerma F., Mariscal F., Nieto M., Pérez M., Pinilla C., Puente T., Ausín I.
Objective: To study the influence of liposomal amphotericin B (L-AMB) on the renal function of intensive care patients with elevated serum creatinine levels (SCL) at the start of L-AMB treatment.
Methods: This is a sub-analysis of a pharmacoepidemiological retrospective study of patients admitted to Spanish intensive care units (ICUs) during 2006 and treated for at least one day with L-AMB. For this sub-analysis, only patients with SCL >1.5 mg/dl at the start of treatment (baseline) were included. Primary endpoint was SCL at the end of L-AMB treatment. Secondary endpoints were: discontinuation of treatment due to nephrotoxicity, and differences among groups (SCL 1.5 mg/dl at the end of treatment vs SCL >1.5 mg/dl at the end of treatment) by dose and duration of L-AMB treatment, along with differences in the percentage of nephrotoxic concomitant drugs administered.
Results: Of the 179 patients admitted to the pharmacoepidemiological study, 49 (27.4%) presented with SCL >1.5 mg/dl (median: 2.3 and range: 1.537.0) at baseline. Of these 49 patients 83.7% were haemodynamically unstable, APACHE II score was 23.3 (SD: 8.8), mean length of ICU stay was 28.6 (SD: 24.0) days and intra-ICU mortality rate was 63.3%. Median dose of L-AMB was 3.6 mg/kg/day (range 16) and median duration of treatment was 12 days (range 133). Concomitant nephrotoxic drugs were taken by 59.2% (n = 39) of patients. At the end of L-AMB treatment, 40.8% (n = 30) of patients presented with SCL 1.5 mg/dl, and the remaining 29 patients maintained SCL >1.5 mg/dl. Of this latter group, only seven patients presented with higher SCL than at baseline, none of them 1.5 x basal line value. No patient discontinued treatment due to nephrotoxicity. Comparing both groups of patients, no differences among dose of L-AMB and duration of treatment were seen. In addition, no differences were observed between groups in the percentages of patients taking nephrotoxic concomitant drugs.
Conclusion: Although this is a small case collection study, L-AMB was safely used in haemodynamically unstable patients with deteriorated renal function. No differences concerning dose and duration of L-AMB treatment, and concomitant nephrotoxic drugs were seen between both groups. L-AMB is a treatment option for high risk patients with deteriorated renal function.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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