The use of prophylactic nebulized liposomal amphotericin B to reduce the risk of CAPA in mechanically ventilated COVID-19 patients on ICU in a large UK tertiary teaching hospital trust.

This prophylactic regimen has been previously described in solid organ lung transplant patients.[7] Based on this evidence, the prolonged turnaround times of fungal diagnostic tests and voriconazole supply issues, the decision was made to initiate antifungal prophylaxis on all mechanically ventilated COVID-19 patients. A further three patients did not meet the ECMM/ISHAM criteria; two patients had radiological findings consistent with CAPA, with BAL GM levels detectable below the ECMM/ISHAM threshold, and a single patient had low-level BAL GM positivity, which did not clinically correlate. A literature review identified a single publication describing antifungal prophylaxis in CAPA patients[6] using nebulized liposomal amphotericin B (AmBisome SP ® sp ) in mechanically ventilated patients. [Extracted from the article]