DREW RH, PALMER SM, DAVIS R, PERFECT JR; Interscience Conference on Antimicrobial Agents and Chemotherapy (42nd : 2002 : San Diego, Calif.).

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2002 Sep 27-30; 42: abstract no. M-1236.

Duke University Medical Center, Durham, NC

BACKGROUND: Prophylactic strategies against IFIs in LTR usually include administering antifungals with activity against Aspergillus spp. However, significant toxicities or interactions may result. aAmB formulations deliver prophylaxis while avoiding adverse effects of systemic administration. We determined the rates of IFIs in LTR receiving aAmB formulations as the sole prophylaxis. METHODS: Amphotericin B deoxycholate (AmBd) 50mg or amphotericin B lipid complex (ABLC) 50mg was administered daily via nebulization for 4 days, then weekly for up to 7 weeks as part of a randomized trial. Doses were doubled in mechanically ventilated patients. IFIs (classified as definite, probable and possible) were characterized during the 60 days post-transplant based on intent-to-treat analysis. RESULTS: 91 LTR (51 male, 40 female age [mean +/- SD] 50.7 +/- 13.5 yrs) received a mean (+/- S.D.) of 6.0 +/- 2.5 treatments. Primary prophylaxis failure was observed in 11 (12.1%) patients (9 definite, 2 probable) and consisted of invasive candidiasis without lung involvement (n=3), anastomotic infections with either Candida spp (n=2) or Aspergillus spp (n=2), C.albicans in pleural fluid (n=1), and candidal esophagitis (n=2). One patient had a granuloma containing yeast on biopsy, with Penicillium spp and S.pruinosum isolated from BAL. In addition, 8 patients (8.8%) had IFIs (1 probable, 7 possible) but were not considered as prophylaxis failures, and 5 (5.5%) received empiric therapy without subsequent evidence of IFI. CONCLUSIONS: Aerosol administration of either AmBd or ABLC without additional systemic prophylaxis produced a low incidence of pulmonary parenchymal fungal disease. Aspergillus infections were limited to the site of anastomosis. Addition of systemic antifungals to aAmB formulations may further reduce nonparenchymal lung and nonpulmonary IFIs.

Publication Types:

• Meeting Abstracts

Keywords:

• Abelcet
• Aerosols
• Amphotericin B
• Antifungal Agents
• Candidiasis
• Deoxycholic Acid
• Drug Combinations
• Female
• Humans
• Lung Diseases
• Male
• Mycoses
• Phosphatidylcholines
• Phosphatidylglycerols
• amphotericin B-deoxycholate
• transplantation

Other ID:

• GWAIDS0027263

UI: 102266887

From Meeting Abstracts