10 years of prophylaxis with nebulized liposomal amphotericin B and the changing epidemiology ofAspergillusspp. infection in lung transplantation

Autor: Isabel Ruiz-Camps, Jordi Riera, Maria-Teresa Martin-Gomez, Víctor Monforte, Piedad Ussetti, Juan Solé, Cristina Berastegui, Joan Gavaldà, Berta Sáez, Maddalena Peghin, Antonio Roman
Rok vydání: 2015
Předmět:
Adult
Graft Rejection
Male
0301 basic medicine
medicine.medical_specialty
Time Factors
medicine.medical_treatment
030106 microbiology
Colony Count
Microbial
Aspergillosis
Risk Assessment
Gastroenterology
Drug Administration Schedule
Cohort Studies
03 medical and health sciences
Postoperative Complications
Amphotericin B
Internal medicine
Administration
Inhalation
medicine
Humans
Lung transplantation
Colonization
Adverse effect
Retrospective Studies
Transplantation
Aspergillus
Chi-Square Distribution
Dose-Response Relationship
Drug
biology
business.industry
Incidence (epidemiology)
Graft Survival
Middle Aged
biology.organism_classification
medicine.disease
Survival Analysis
Surgery
Primary Prevention
Treatment Outcome
Tolerability
Female
business
Follow-Up Studies
Lung Transplantation
medicine.drug
Zdroj: Transplant International. 29:51-62
ISSN: 0934-0874
2003-2013
DOI: 10.1111/tri.12679
Popis: The aim of this study was to assess the outcome and tolerability of prophylactic nebulized liposomal amphotericin B (n-LAB) in lung transplant recipients (LTR) and the changing epidemiology of Aspergillus spp. infection and colonization. We performed an observational study including consecutive LTR recipients (2003-2013) undergoing n-LAB prophylaxis lifetime. A total of 412 patients were included (mean postoperative follow-up 2.56 years; IQR 1.01-4.65). Fifty-three (12.8%) patients developed 59 Aspergillus spp. infections, and 22 invasive aspergillosis (overall incidence 5.3%). Since 2009, person-time incidence rates of Aspergillus spp. colonization and infection decreased (2003-2008, 0.19; 2009-2014, 0.09; P = 0.0007), but species with reduced susceptibility or resistance to amphotericin significantly increased (2003-2008, 38.1% vs 2009-2014, 58.1%; P = 0.039). Chronic lung allograft dysfunction (CLAD) was associated with Aspergillus spp. colonization and infection (HR 24.4, 95% CI 14.28-41.97; P = 0.00). Only 2.9% of patients presented adverse effects, and 1.7% required discontinuation. Long-term administration of prophylaxis with n-LAB has proved to be tolerable and can be used for preventing Aspergillus spp. infection in LTR. Over the last years, the incidence of Aspergillus spp. colonization and infection has decreased, but species with reduced amphotericin susceptibility or resistance are emerging. CLAD is associated with Aspergillus spp. colonization and infection.
Databáze: OpenAIRE
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