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Prophylaxis of respiratory tract invasive fungal infections with aerosolised amphotericin-B deoxycholate in allogeneic haematopoietic stem cell transplant recipients

Abstract number: P1546

Cavattoni I.M., Morello E., Amato B., Casini M., Vedovelli C., Mian P., Pagani L.

Objectives: Prophylaxis of fungal infections (IFIs) is still a major challenge in patients (pts) undergoing stem cell transplantation (HSCT). The aim of this retrospective study was to evaluate the impact of prophylactic aerosolised amphotericin-B deoxycholate (d-AmB) on respiratory tract IFIs in a homogeneous cohort of allogeneic HSCT pts, transplanted at our institution.

Methods: Since 1999, 87 consecutive pts were transplanted from matched related (N=65) or unrelated donor (N=22). Analysis was performed on 78 evaluable pts, in order to monitor the prevalence of possible, probable, proven IFIs of the respiratory tract within 40 days after HSCT. Conventional antifungal prophylaxis was based on the association of IV/PO fluconazole (400 mg/d), plus aerosolised d-AmB (15 mg bid) in 58 out of 78 cases (74%). All the pts were screened before transplant and followed-up thereafter with CT or x-rays (paranasal sinuses, thorax), galactomannan antigenaemia and surveillance swabs. Chi square test was performed to evaluate correlations between variables.

Results: Aerosolised d-AmB was administered to 74 pts for a median time of 16 days (range 2–45). Prolonged administration was not associated with increased life-threatening bacterial infections, nor severe adverse events were observed; only a pt developed moderate bronchial spasm. In 13 pts, aerosolised d-AmB was delivered for less than 7 days, due to worsened clinical conditions, or poor compliance. In this group, proven IFIs were diagnosed in 2 pts (1 mucormycosis and 1 fusariosis), possible aspergillosis in one and probable aspergillosis in another one. A shortened administration (<7 days) of aerosolised d-AmB was associated with an increased risk of IFIs (p = 0.004). Overall, 94% of pts did not experience IFIs and none died due to IFIs. Nine pts had a pre-transplant nasal swab positive for Aspergillus spp., and 8 of them received aerosolised d-AmB; their subsequent surveillance swabs proved negative. The only patient with positive swab who did not undergo aerosolised d-AmB due to bronchial spasm developed a possible aspergillosis.

Conclusions: Prolonged aerosolised d-AmB seems to play a role in preventing respiratory tract IFIs, but a randomised controlled trial is warranted, in order to verify the impact of such prophylactic regimen in this setting.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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