Liposomal amphotericinB in intensive care unit patients previously treated with fluconazole: a retrospective, efficacy and safety multi-centre study

Abstract number: P1740

Álvarez-Lerma F., Rialp G., Nieto M., Aragón C., Puente T., Ausín I.

Objective: Efficacy and safety of Liposomal amphotericin B (L-AmB) in intensive care unit (ICU) patients previously treated with fluconazole.

Methods: Retrospective, multicentre study of patients admitted to ICUs and treated with L-AMB as second line treatment after fluconazole. Invasive fungal infections (IFIs) were classified as proven, probable or possible

Results: 41 patients were included, 60% were male and median age was 62 years. Mean length in ICU was 31.8 (SD:22.6) days and mortality rate in ICU 59%. Mean APACHE II score was 20.7 (SD:7.8) and at admission 34% of the patients had severe sepsis or septic shock. Most common pathologies were surgery (49%) and medical pathology (39%). Invasive fungal infections were proven, probable and possible in 42%, 19% and 32%, of patients, respectively, and not classified in 7%. Most common fungi identified (it was possible several species) were C. glabrata (56%) C. albicans (54%) C. parapsilosis (15%) and Aspergillus spp (12%). Most common reasons for choosing L-AmB were: severe sepsis or septic shock (61%) L-AmB spectrum including suspicion of filamentous fungi (56%) guidelines application (42%) and infection localisation (24%). Median Candida score was 4.0 and median Sevilla score was 11.0. Mean duration of L-AmB treatment was 15.2 days and mean dose was 4.2 mg/kg/day. Satisfactory clinical response (complete and partial response) was achieved in 49% (95% CI:34, 64) of patients and microbiological response (negative culture) in 44% (95% CI:29, 59) of patients in the intention to treat analysis. Within evaluable patients, satisfactory clinical and microbiological responses were: 61% (95% CI:44, 77) and 82% (95% CI:66, 98), respectively. Eight treatment-related AEs were reported, but only 1 was serious: a case of renal failure requiring a change in antifungal treatment. There was no change in the overall mean creatinine value at the end of treatment in the patients treated with L-AMB, despite the fact that 51% of the patients were receiving nephrotoxic drugs concomitantly.

Conclusion: L-AmB as second line treatment after fluconazole showed high clinical and microbiological response in evaluable patients. L-AmB was well tolerated even in patients with concomitant nephrotoxic drugs. L-AmB was mainly selected for patients with severe sepsis or septic shock and also due to its broad spectrum activity. L-AmB can be considered an effective and safe option both in empiric and confirmed IFIs in critically ill patients after fluconazole treatment.