Antifungal prophylaxis with nebulized amphotericin-B in solid-organ transplant recipients with severe COVID-19 : a retrospective observational study
Rombauts, Alexander (Hospital Universitari de Bellvitge)
Bodro, Marta (Hospital Clínic i Provincial de Barcelona)
Gumucio-Sanguino, Víctor (Hospital Universitari de Bellvitge)
Carbonell, Irene (Hospital Clínic i Provincial de Barcelona)
Favà, Alexandre (Hospital Universitari de Bellvitge)
Lladó, Laura (Hospital Universitari de Bellvitge)
González-Costello, José (Hospital Universitari de Bellvitge)
Oppenheimer, Federico (Hospital Clínic i Provincial de Barcelona)
Castel-Lavilla, María Ángeles (Hospital Clínic i Provincial de Barcelona)
Len, Oscar (Hospital Universitari Vall d'Hebron)
Marquez-Algaba, Ester (Hospital Universitari Vall d'Hebron)
Nuvials, Xavier (Hospital Universitari Vall d'Hebron)
Martínez González, Daniel (Hospital Universitari Vall d'Hebron)
Lacasa, Judith Sacanell (Hospital Universitari Vall d'Hebron)
Carratalà, Jordi (Institut d'Investigació Biomèdica de Bellvitge)
Sabé, Núria (Hospital Universitari de Bellvitge)
Universitat Autònoma de Barcelona

Fecha:	2023
Resumen:	COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as a frequent complication in the intensive care unit (ICU). However, little is known about this life-threatening fungal superinfection in solid organ transplant recipients (SOTRs), including whether targeted anti-mold prophylaxis might be justified in this immunosuppressed population. We performed a multicentric observational retrospective study of all consecutive ICU-admitted COVID-19 SOTRs between August 1, 2020 and December 31, 2021. SOTRs receiving antifungal prophylaxis with nebulized amphotericin-B were compared with those without prophylaxis. CAPA was defined according the ECMM/ISHAM criteria. Sixty-four SOTRs were admitted to ICU for COVID-19 during the study period. One patient received antifungal prophylaxis with isavuconazole and was excluded from the analysis. Of the remaining 63 SOTRs, nineteen (30. 2%) received anti-mold prophylaxis with nebulized amphotericin-B. Ten SOTRs who did not receive prophylaxis developed pulmonary mold infections (nine CAPA and one mucormycosis) compared with one who received nebulized amphotericin-B (22. 7% vs 5. 3%; risk ratio 0. 23; 95%CI 0. 032-1. 68), but with no differences in survival. No severe adverse events related to nebulized amphotericin-B were recorded. SOTRs admitted to ICU with COVID-19 are at high risk for CAPA. However, nebulized amphotericin-B is safe and might reduce the incidence of CAPA in this high-risk population. A randomized clinical trial to confirm these findings is warranted.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	COVID-19 ; SARS-CoV-2 ; Solid-organ transplant recipients ; Amphotericin-b ; Prophylaxis ; Aspergillus spp ; CAPA ; Aspergillosis
Publicado en:	Frontiers in cellular and infection microbiology, Vol. 13 (april 2023) , ISSN 2235-2988

DOI: 10.3389/fcimb.2023.1165236
PMID: 37180450

6 p, 620.5 KB

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