Author:

Keywords:

Science & Technology, Life Sciences & Biomedicine, Infectious Diseases, Mycology, Veterinary Sciences, Invasive fungal infection, liposomal amphotericin B, outpatient parenteral antibiotic treatment, triazole resistance, antifungal stewardship, ASPERGILLUS-FUMIGATUS, AZOLE RESISTANCE, EUROPEAN ORGANIZATION, DISEASES SOCIETY, RISK-FACTORS, SAFETY, EFFICACY, MANAGEMENT, PHARMACOKINETICS, PHARMACODYNAMICS, Adolescent, Adult, Aged, Aged, 80 and over, Ambulatory Care, Amphotericin B, Antifungal Agents, Aspergillosis, Drug Resistance, Fungal, Female, Humans, Invasive Fungal Infections, Male, Middle Aged, Mucormycosis, Netherlands, Young Adult, 1108 Medical Microbiology, Microbiology, 3107 Microbiology, 3202 Clinical sciences, 3207 Medical microbiology

Abstract:

Triazole resistant A. fumigatus has been documented in many parts of the world. In the Netherlands, incidence is now above 10% and results in the need for long-term parenteral therapy with liposomal amphotericin B (LAmB). The long terminal half-life of LAmB suggests that intermittent dosing could be effective, making the application of outpatient antifungal therapy (OPAT) possible. Here, we report our experience with the use of OPAT for Invasive Fungal Infections (IFI). All adult patients treated with LAmB with a 2 or 3 times weekly administration via the outpatient departments in four academic tertiary care centers in the Netherlands and Belgium since January 2010 were included in our analysis. Patient characteristics were collected, as well as information about diagnostics, therapy dose and duration, toxicity, treatment history and outcome of the IFI. In total, 18 patients were included. The most frequently used regimen (67%) was 5 mg/kg 3 times weekly. A partial response to the daily treatment prior to discharge was confirmed by CT-scan in 17 (94%) of patients. A favorable outcome was achieved in 13 (72%) patients. Decrease in renal function occurred in 10 (56%) cases but was reversible in all and was treatment limiting in one patient only. The 100-day mortality and 1-year mortality after initiation of OPAT were 0% and 6%, respectively. In a selected population, and after confirmation of initial response to treatment, our data support the use of OPAT with LAmB for treatment of IFI in an intermittent dosing regimen.