Sun HY, Alexander BD, Lortholary O, Dromer F, Forrest GN, Lyon GM, Somani J, Gupta KL, Busto RD, Pruett TL, Sifri CD, Limaye AP, John GT, Klintmalm GB, Pursell K, Stosor V, Morris MI, Dowdy LA, Munoz P, Kalil AC, Garcia-Diaz J, Orloff S, House AA, Houston S, Wray D, Huprikar S, Johnson LB, Humar A, Razonable RR, Husain S, Singh N
Lipid Formulations of Amphotericin B Significantly Improve Outcome in Solid Organ Transplant Recipients with Central Nervous System Cryptococcosis. [JOURNAL ARTICLE]
Clin Infect Dis 2009 Nov 3.
Background. Whether outcome of central nervous system (CNS) cryptococcosis in solid organ transplant recipients treated with lipid formulations of amphotericin B is different from the outcome of the condition treated with amphotericin B deoxycholate (AmBd) is not known. Methods. We performed a multicenter study involving a cohort comprising consecutive solid organ transplant recipients with CNS cryptococcosis.
Results. Of 75 patients treated with polyenes as induction regimens, 55 (73.3%) received lipid formulations of amphotericin B and 20 (26.7%) received AmBd. Similar proportions of patients in both groups had renal failure at baseline ([Formula: see text]). Overall, mortality at 90 days was 10.9% in the group that received lipid formulations of amphotericin B and 40.0% in the group that received AmBd. In univariate analysis, nonreceipt of calcineurin inhibitors ([Formula: see text]), renal failure at baseline ([Formula: see text]), and fungemia ([Formula: see text]) were significantly associated with mortality. Compared with AmBd, lipid formulations of amphotericin B were associated with a lower mortality ([Formula: see text]). Mortality did not differ between patients receiving lipid formulations of amphotericin B with or without flucytosine ([Formula: see text]). In stepwise logistic regression analysis, renal failure at baseline (odds ratio [OR], 4.61; 95% confidence interval [CI], 1.02-20.80; [Formula: see text]) and fungemia (OR, 10.66; 95% CI, 2.08-54.55; [Formula: see text]) were associated with an increased mortality, whereas lipid formulations of amphotericin B were associated with a lower mortality (OR, 0.11; 95% CI, 0.02-0.57; [Formula: see text]).
Conclusions. Lipid formulations of amphotericin B were independently associated with better outcome and may be considered as the first-line treatment for CNS cryptococcosis in these patients.
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