Lipid Formulations of Amphotericin B Significantly Improve Outcome in Solid Organ Transplant Recipients with Central Nervous System Cryptococcosis

被引：47

作者：

Sun, Hsin-Yun ^{[2
,21
,22
]}

Alexander, Barbara D. ^{[3
]}

Lortholary, Olivier ^{[24
,25
]}

Dromer, Francoise ^{[23
]}

Forrest, Graeme N. ^{[4
]}

Lyon, G. Marshall ^{[5
]}

Somani, Jyoti ^{[5
]}

Gupta, Krishan L. ^{[26
]}

del Busto, Ramon ^{[6
]}

Pruett, Timothy L. ^{[8
]}

Sifri, Costi D. ^{[8
]}

Limaye, Ajit P. ^{[9
]}

John, George T. ^{[27
]}

Klintmalm, Goran B. ^{[10
]}

Pursell, Kenneth ^{[11
]}

Stosor, Valentina ^{[12
]}

Morris, Michelle I. ^{[13
]}

Dowdy, Lorraine A. ^{[13
]}

Munoz, Patricia ^{[28
,29
]}

Kalil, Andre C. ^{[15
]}

Garcia-Diaz, Julia ^{[16
]}

Orloff, Susan ^{[17
]}

House, Andrew A. ^{[30
]}

Houston, Sally ^{[14
]}

Wray, Dannah ^{[18
]}

Huprikar, Shirish ^{[19
]}

Johnson, Leonard B. ^{[7
]}

Humar, Atul ^{[31
]}

Razonable, Raymund R. ^{[20
]}

Husain, Shahid ^{[1
]}

Singh, Nina ^{[1
,2
]}

机构：

[1] Univ Pittsburgh, Pittsburgh, PA USA

[2] VA Pittsburgh Healthcare Syst, Pittsburgh, PA USA

[3] Duke Univ, Med Ctr, Durham, NC USA

[4] Univ Maryland, Sch Med, Baltimore, MD 21201 USA

[5] Emory Univ, Atlanta, GA 30322 USA

[6] Henry Ford Hosp, Detroit, MI 48202 USA

[7] St Johns Hosp, Detroit, MI USA

[8] Univ Virginia, Charlottesville, VA USA

[9] Univ Washington, Seattle, WA 98195 USA

[10] Baylor Univ, Med Ctr, Dallas, TX USA

[11] Univ Chicago, Chicago, IL 60637 USA

[12] Northwestern Univ, Chicago, IL 60611 USA

[13] Univ Miami, Miller Sch Med, Miami, FL 33136 USA

[14] Tampa Gen Hosp, Tampa, FL 33606 USA

[15] Univ Nebraska, Omaha, NE 68182 USA

[16] Alton Ochsner Med Fdn & Ochsner Clin, New Orleans, LA 70121 USA

[17] Oregon Hlth & Sci Univ, Portland, OR USA

[18] Med Univ S Carolina, Charleston, SC 29425 USA

[19] Mt Sinai Med Ctr, New York, NY 10029 USA

[20] Mayo Clin, Rochester, MN USA

[21] Natl Taiwan Univ, Coll Med, Taipei 10764, Taiwan

[22] Natl Taiwan Univ Hosp, Dept Internal Med, Taipei 100, Taiwan

[23] Inst Pasteur, Paris, France

[24] Hop Necker Enfants Malad, Fac Med Paris Descartes, Paris, France

[25] Hop Necker Enfants Malad, Inst Pasteur, Paris, France

[26] Postgrad Inst Med Educ & Res, Chandigarh 160012, India

[27] Christian Med Coll & Hosp, Vellore, Tamil Nadu, India

[28] Hosp Gen Univ Gregorio Maranon, Madrid, Spain

[29] CIBER Enfermedades Resp, Madrid, Spain

[30] Univ Western Ontario, London, ON, Canada

[31] Toronto Gen Hosp, Univ Hlth Network, Toronto, ON, Canada

来源：

CLINICAL INFECTIOUS DISEASES | 2009年 / 49卷 / 11期

基金：

美国国家卫生研究院;

关键词：

INVASIVE FUNGAL-INFECTIONS; HEMATOPOIETIC STEM-CELL; NEOFORMANS INFECTION; MENINGITIS; COMBINATION; AIDS; PROPHYLAXIS; MANAGEMENT; TOXICITY; AMBISOME;

D O I：

10.1086/647948

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background. Whether outcome of central nervous system (CNS) cryptococcosis in solid organ transplant recipients treated with lipid formulations of amphotericin B is different from the outcome of the condition treated with amphotericin B deoxycholate (AmBd) is not known. Methods. We performed a multicenter study involving a cohort comprising consecutive solid organ transplant recipients with CNS cryptococcosis. Results. Of 75 patients treated with polyenes as induction regimens, 55 (73.3%) received lipid formulations of amphotericin B and 20 (26.7%) received AmBd. Similar proportions of patients in both groups had renal failure at baseline (P = .94). Overall, mortality at 90 days was 10.9% in the group that received lipid formulations of amphotericin B and 40.0% in the group that received AmBd. In univariate analysis, nonreceipt of calcineurin inhibitors (P = .034), renal failure at baseline (P = .016), and fungemia (P = .003) were significantly associated with mortality. Compared with AmBd, lipid formulations of amphotericin B were associated with a lower mortality (P = .007). Mortality did not differ between patients receiving lipid formulations of amphotericin B with or without flucytosine (P = .349). In stepwise logistic regression analysis, renal failure at baseline (odds ratio [OR], 4.61; 95% confidence interval [CI], 1.02-20.80; P = .047) and fungemia (OR, 10.66; 95% CI, 2.08-54.55; P = .004) were associated with an increased mortality, whereas lipid formulations of amphotericin B were associated with a lower mortality (OR, 0.11; 95% CI, 0.02-0.57; P = .008). Conclusions. Lipid formulations of amphotericin B were independently associated with better outcome and may be considered as the first-line treatment for CNS cryptococcosis in these patients.

引用

页码：1721 / 1728

页数：8

共 36 条

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