Isavuconazole Is as Effective as and Better Tolerated Than Voriconazole for Antifungal Prophylaxis in Lung Transplant Recipients.

Autor:	Samanta P; Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Clancy CJ; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.; Division of Infectious Diseases, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA., Marini RV; Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Rivosecchi RM; Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., McCreary EK; Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Shields RK; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.; Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Falcione BA; Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Viehman A; Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Sacha L; Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Kwak EJ; Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Silveira FP; Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA., Sanchez PG; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.; Department of Cardiothoracic Surgery, Division of Lung Transplantation and Lung Failure, University of Pittsburgh Medical Center, Pennsylvania, USA., Morrell M; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.; Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Clarke L; Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Nguyen MH; Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2021 Aug 02; Vol. 73 (3), pp. 416-426.
DOI:	10.1093/cid/ciaa652
Abstrakt:	Background: Invasive fungal infections (IFIs) are common following lung transplantation. Isavuconazole is unstudied as prophylaxis in organ transplant recipients. We compared effectiveness and tolerability of isavuconazole and voriconazole prophylaxis in lung transplant recipients. Methods: A single-center, retrospective study of patients who received isavuconazole (September 2015-February 2018) or voriconazole (September 2013-September 2015) for antifungal prophylaxis. IFIs were defined by EORTC/MSG criteria. Results: Patients received isavuconazole (n = 144) or voriconazole (n = 156) for median 3.4 and 3.1 months, respectively. Adjunctive inhaled amphotericin B (iAmB) was administered to 100% and 41% of patients in the respective groups. At 1 year, 8% of patients receiving isavuconazole or voriconazole developed IFIs. For both groups, 70% and 30% of IFIs were caused by molds and yeasts, respectively, and breakthrough IFI (bIFI) rate was 3%. Outcomes did not significantly differ for patients receiving or not receiving iAmB. Independent risk factors for bIFI and breakthrough invasive mold infection (bIMI) were mold-positive respiratory culture and red blood cell transfusion >7 units at transplant. Bronchial necrosis >2 cm from anastomosis and basiliximab induction were also independent risk factors for bIMI. Isavuconazole and voriconazole were discontinued prematurely due to adverse events in 11% and 36% of patients, respectively (P = .0001). Most common causes of voriconazole and isavuconazole discontinuation were hepatotoxicity and lack of oral intake, respectively. Patients receiving ≥90 days prophylaxis had fewer IFIs at 1 year (3% vs 9%, P = .02). IFIs were associated with increased mortality (P = .0001) and longer hospitalizations (P = .0005). Conclusions: Isavuconazole was effective and well tolerated as antifungal prophylaxis following lung transplantation. (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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