Lipid formulations of amphotericin B significantly improve outcome in solid organ transplant recipients with central nervous system cryptococcosis
Journal
Clinical Infectious Diseases
Journal Volume
49
Journal Issue
11
Pages
1721-1728
Date Issued
2009
Author(s)
Alexander B.D.
Lortholary O.
Dromer F.
Forrest G.N.
Lyon G.M.
Somani J.
Gupta K.L.
Del Busto R.
Pruett T.L.
Sifri C.D.
Limaye A.P.
John G.T.
Klintmalm G.B.
Pursell K.
Stosor V.
Morris M.I.
Dowdy L.A.
Munoz P.
Kalil A.C.
Garcia-Diaz J.
Orloff S.
House A.A.
Houston S.
Wray D.
Huprikar S.
Johnson L.B.
Humar A.
Razonable R.R.
Husain S.
Singh N.
Abstract
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 (Pp.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; Pp.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. ? 2009 by the Infectious Diseases Society of America. All rights reserved.
SDGs
Other Subjects
amphotericin B; amphotericin B deoxycholate; amphotericin B lipid complex; cyclosporin A; flucytosine; immunosuppressive agent; mycophenolic acid 2 morpholinoethyl ester; prednisone; tacrolimus; adult; article; central nervous system infection; cerebrospinal fluid culture; clinical trial; cohort analysis; controlled study; cryptococcosis; cytomegalovirus infection; drug efficacy; drug formulation; female; fungemia; graft rejection; heart transplantation; human; immunosuppressive treatment; kidney failure; kidney transplantation; liver transplantation; logistic regression analysis; lung transplantation; major clinical study; male; mortality; multicenter study; organ transplantation; pancreas transplantation; priority journal; risk assessment; treatment outcome
Publisher
Oxford University Press
Type
journal article