Treatment outcomes in patients receiving conventional amphotericin B therapy: A prospective multicentre study in Taiwan
Journal
Journal of Antimicrobial Chemotherapy
Journal Volume
57
Journal Issue
6
Pages
1181-1188
Date Issued
2006
Author(s)
Kumar R.N.
Feng Y.-H.
Ho C.-H.
You J.-Y.
Liao C.-C.
Tseng C.-H.
Mavros P.
Gerth W.C.
Abstract
Objectives: To evaluate treatment outcomes and healthcare resource use with conventional amphotericin B therapy for invasive fungal infections (IFIs). Patients and methods: A prospective observational study in hospitalized adult patients receiving amphotericin B treatment was undertaken at four hospitals in Taiwan. Patients were observed from the start of therapy to hospital discharge. Results: A total of 108 patients (October 2000 to April 2002) were included in the study. Proven or probable IFIs as defined by the EORTC/ MSG criteria were the reasons for the initiation of amphotericin B in 35.2% of the sample. A total of 24.1% patients developed nephrotoxicity (NT) (defined as a 50% increase in the baseline serum creatinine and achieving a peak of at least 2.0 mg/dL). Treatment of proven/probable IFIs [odds ratio (OR) = 4.16, 95% confidence interval (CI) = 1.61-10.75] was a significant predictor of the development of NT. The in-hospital mortality rate was 38.0%. Proven/probable IFIs (OR = 6.93, 95% CI = 2.62-18.29) and the development of NT (OR = 3.68, 95% CI = 1.22-11.04) were independent predictors of in-hospital mortality. For patients alive at discharge, those with NT had a trend of longer hospital stay compared with patients who had not developed NT (mean, 49.3 ± 18.2 versus 29.3 ± 22.3 days, P = 0.069). For patients who died, those who had developed NT died sooner (15.5 ± 16.7 versus 33. 8 ± 26.9 days, P = 0.0004). Conclusions: NT was associated with accelerated mortality and increased hospital stay for patients who survived. Using amphotericin B carefully or the use of antifungal agents with less potential for NT might improve patient outcomes. ? 2006 Oxford University Press.
SDGs
Other Subjects
aminoglycoside antibiotic agent; amphotericin B; antineoplastic agent; contrast medium; creatinine; immunosuppressive agent; nonsteroid antiinflammatory agent; polypeptide antibiotic agent; amphotericin B; creatinine; abnormally high substrate concentration in blood; adult; aged; article; aspergillosis; candidiasis; clinical trial; confidence interval; controlled clinical trial; controlled study; creatinine blood level; cryptococcosis; drug fatality; drug megadose; female; hospital discharge; hospital patient; human; length of stay; major clinical study; male; mortality; multicenter study; mycosis; nephrotoxicity; observational study; prediction; prospective study; statistical significance; Taiwan; treatment outcome; blood; drug effect; kidney; middle aged; Adult; Aged; Amphotericin B; Creatinine; Female; Humans; Kidney; Length of Stay; Male; Middle Aged; Mycoses; Prospective Studies; Taiwan; Treatment Outcome
Type
journal article