1. Antifungal prophylaxis with nebulized amphotericin-B in solid-organ transplant recipients with severe COVID-19: a retrospective observational study
- Author
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Alexander Rombauts, Marta Bodro, Victor Daniel Gumucio, Irene Carbonell, Àlex Favà, Laura Lladó, José González-Costello, Federico Oppenheimer, María Ángeles Castel-Lavilla, Oscar Len, Ester Marquez-Algaba, Xavier Nuvials-Casals, Daniel Martínez González, Judith Sacanell Lacasa, Jordi Carratalà, Nuría Sabé, Institut Català de la Salut, [Rombauts A] Department of Infectious Diseases, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain. [Bodro M, Carbonell I] Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona, Spain. [Daniel Gumucio V] Department of Intensive Care Medicine, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain. [Favà À] Renal Transplant Unit, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain. [Lladó L] Liver Transplant Unit, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain. [Len O] Servei de Malalties Infeccioses, Vall d'Hebron Hospital Universitari, Barcelona, Spain. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain. [Marquez-Algaba E] Servei de Malalties Infeccioses, Vall d'Hebron Hospital Universitari, Barcelona, Spain. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. [Nuvials-Casals X, Martínez González D, Sacanell Lacasa J] Servei de Medicina Intensiva, Vall d'Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
- Subjects
Microbiology (medical) ,acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antiinfecciosos::antifúngicos [COMPUESTOS QUÍMICOS Y DROGAS] ,Otros calificadores::/uso terapéutico [Otros calificadores] ,Immunology ,Surgical Procedures, Operative::Transplantation::Organ Transplantation [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,Trasplantació d'òrgans, teixits, etc ,Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES] ,Medicaments antifúngics - Ús terapèutic ,Microbiology ,COVID-19 (Malaltia) ,Infectious Diseases ,Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Antifungal Agents [CHEMICALS AND DRUGS] ,virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES] ,intervenciones quirúrgicas::trasplante::trasplante de órganos [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Other subheadings::/therapeutic use [Other subheadings] - Abstract
Aspergillosis; COVID-19; Prophylaxis Aspergilosis; COVID-19; Profilaxis Aspergilosi; COVID 19; Profilaxi 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. AR received a predoctoral research grant from the Instituto de Salud Carlos III, Spanish Ministry of Science, Innovation and Universities, (PFIS grant FI18/00183). This work was supported by the Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain. We thank CERCA Programme/Generalitat de Catalunya for institutional support.
- Published
- 2023