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首页> 外文期刊>P & T: a peer-reviewed journal for formulary management >Comparison of adverse events and hospital length of stay associated with various amphotericin B formulations: Sequential conventional amphotericin B/lipid versus lipid-only therapy for the treatment of invasive fungal infections in hospitalized patients
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Comparison of adverse events and hospital length of stay associated with various amphotericin B formulations: Sequential conventional amphotericin B/lipid versus lipid-only therapy for the treatment of invasive fungal infections in hospitalized patients

机译：与各种两性霉素B制剂相关的不良事件和住院时间的比较：常规的两性霉素B /脂质疗法与仅脂质疗法相继治疗住院患者的侵袭性真菌感染

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Purpose: Patients with invasive fungal infections are often treated initially with conventional amphotericin B deoxycholate (CAB), followed by a switch to lipid-based formulations of amphotericin B (LF-AMB). Our study examined adverse events and hospital length of stay (LOS) among adults who received LF-AMB exclusively or CAB followed by LF-AMB (CAB/LF-AMB). Methods: Data were extracted from the Cerner Health Facts database. The study included adults with evidence of infection by Aspergillus, Candida, or Cryptococcus in addition to either renal insufficiency, a clinical condition suggesting intolerance to CAB, or CAB exposure within 90 days of admission. Nephrotoxicity was defined as a serum creatinine (SCr) level exceeding a 100% increase from baseline and an absolute level above 1.2 mg/dL. We used a hierarchical mixed-effect logistic regression model with nephrotoxicity as the outcome for the multivariate analysis. Results: The study included 327 LF-AMB and 81 CAB/ LF-AMB patients with similar demographics and baseline SCr values. The mean pre-to-post percentage increase in SCr levels was greater for CAB/LF-AMB (122.9%) compared with LF-AMB (62.2%) (P < 0.001). The multivariate-adjusted odds ratio of nephrotoxicity was 5.93, for a 95% confidence interval of 2.92 to 12.05 (P < 0.001) for CAB/LF-AMB compared with LF-AMB. Hypokalemia, hypomagnesemia, and infusion-related reactions were more frequent with CAB/LF-AMB. Compared with the LF-AMB group, the CAB/LF-AMB patients had a longer post-amphotericin B LOS (24.1 days vs. 15.7 days, respectively; P < 0.001), with a marginal effect of 4.5 days longer for those receiving CAB/LF-AMB (P = 0.016). Conclusion: In this retrospective study, we noted a significantly longer post-amphotericin B LOS and a greater frequency of adverse events, including nephrotoxicity, for patients whose initial treatment was CAB and who were switched to LF-AMB, compared with patients who received LF-AMB only.
机译：目的：侵袭性真菌感染的患者通常首先用常规的两性霉素B脱氧胆酸盐（CAB）治疗，然后转向使用基于脂质的两性霉素B（LF-AMB）制剂。我们的研究检查了仅接受LF-AMB或CAB继之LF-AMB（CAB / LF-AMB）的成年人的不良事件和住院时间（LOS）。方法：从Cerner Health Facts数据库中提取数据。该研究包括成年患者，除了肾功能不全，临床症状表明对CAB不耐受或入院90天内暴露于CAB外，还具有被曲霉菌，念珠菌或隐球菌感染的证据。肾毒性定义为血清肌酐（SCr）水平比基线增加100％以上，绝对水平超过1.2 mg / dL。我们使用具有肾毒性的分层混合效应逻辑回归模型作为多变量分析的结果。结果：这项研究包括327名LF-AMB和81名CAB / LF-AMB患者，其人口统计学和基线SCr值相似。与LF-AMB（62.2％）相比，CAB / LF-AMB的SCr水平的平均前后涨幅更大（122.9％）（P <0.001）。与LF-AMB相比，CAB / LF-AMB肾毒性的多元调整比值比为5.93，95％置信区间为2.92至12.05（P <0.001）。低血钾，低镁血症和与输注相关的反应在CAB / LF-AMB中更为常见。与LF-AMB组相比，CAB / LF-AMB患者接受两性霉素B LOS的时间更长（分别为24.1天和15.7天; P <0.001），而接受CAB的患者的边际效应延长了4.5天/ LF-AMB（P = 0.016）。结论：在这项回顾性研究中，我们注意到与接受LF治疗的患者相比，最初接受CAB治疗并改用LF-AMB的患者接受两性霉素B的LOS明显更长，且发生不良事件（包括肾毒性）的频率更高。 -仅适用于AMB。

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