JAC Advance Access originally published online on April 4, 2006
Journal of Antimicrobial Chemotherapy 2006 57(6):1181-1188; doi:10.1093/jac/dkl107
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Treatment outcomes in patients receiving conventional amphotericin B therapy: a prospective multicentre study in Taiwan
1 Department of Internal Medicine, National Taiwan University Hospital Taipei, Taiwan 2 Merck & Co. Whitehouse Station, NJ, USA 3 National Cheng Kung University Tainan, Taiwan 4 Veterans General Hospital Taipei, Taiwan 5 Chang Gung Memorial Hospital Tao-Yuan, Taiwan 6 Department of Medicine, National Taiwan University College of Medicine Taipei, Taiwan
Received 11 November 2005; returned 15 December 2005; revised 19 January 2006; accepted 7 March 2006
*Correspondence address. Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan 100. Tel: +886-23123456 ext. 5054; Fax: +886-2-23971412; E-mail: ycc{at}ha.mc.ntu.edu.tw
Objectives: To evaluate treatment outcomes and healthcare resource use with conventional amphotericin B therapy for invasive fungal infections (IFIs).
Patients and methods: A prospective observational study in hospitalized adult patients receiving amphotericin B treatment was undertaken at four hospitals in Taiwan. Patients were observed from the start of therapy to hospital discharge.
Results: A total of 108 patients (October 2000 to April 2002) were included in the study. Proven or probable IFIs as defined by the EORTC/MSG criteria were the reasons for the initiation of amphotericin B in 35.2% of the sample. A total of 24.1% patients developed nephrotoxicity (NT) (defined as a 50% increase in the baseline serum creatinine and achieving a peak of at least 2.0 mg/dL). Treatment of proven/probable IFIs [odds ratio (OR) = 4.16, 95% confidence interval (CI) = 1.61–10.75] was a significant predictor of the development of NT. The in-hospital mortality rate was 38.0%. Proven/probable IFIs (OR = 6.93, 95% CI = 2.62–18.29) and the development of NT (OR = 3.68, 95% CI = 1.22–11.04) were independent predictors of in-hospital mortality. For patients alive at discharge, those with NT had a trend of longer hospital stay compared with patients who had not developed NT (mean, 49.3 ± 18.2 versus 29.3 ± 22.3 days, P = 0.069). For patients who died, those who had developed NT died sooner (15.5 ± 16.7 versus 33. 8 ± 26.9 days, P = 0.0004).
Conclusions: NT was associated with accelerated mortality and increased hospital stay for patients who survived. Using amphotericin B carefully or the use of antifungal agents with less potential for NT might improve patient outcomes.
Keywords: adverse effects , nephrotoxicity , medical resources , length of stay , mortality , invasive fungal infections