JAC Advance Access published online on April 4, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl107
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1 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
* To whom correspondence should be addressed. 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.
Received November 11, 2005
Revised January 19, 2006
Accepted March 7, 2006
Original article
Treatment outcomes in patients receiving conventional amphotericin B therapy: a prospective multicentre study in Taiwan
Chien-Yuan Chen 1,
Ritesh N. Kumar 2,
Yin-Hsun Feng 3,
Chao-Hung Ho 4,
Jie-Yu You 4,
Chi-Chou Liao 5,
Chiung-Hui Tseng 5,
Panagiotis Mavros 2,
William C. Gerth 2,
and
Yee-Chun Chen 6 *
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 Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
Yee-Chun Chen, E-mail: ycc{at}ha.mc.ntu.edu.tw
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