scholarly journals Experience with Liposomal Amphotericin B in Outpatient Parenteral Antimicrobial Therapy (OPAT)

2021 ◽  
Author(s):  
Yvonne J. Burnett ◽  
Andrej Spec ◽  
Mohamed M. Ahmed ◽  
William G. Powderly ◽  
Yasir Hamad
Keyword(s):  
Amphotericin B ◽  
Antimicrobial Therapy ◽  
Liposomal Amphotericin ◽  
Kidney Injury ◽  
Outpatient Setting ◽  
Primary Objective ◽  
Liposomal Amphotericin B ◽  
Close Monitoring ◽  
Outpatient Parenteral Antimicrobial Therapy

Background: Outpatient parenteral antimicrobial therapy (OPAT) is a safe, effective, and convenient treatment strategy for patients receiving intravenous antimicrobials in the outpatient setting; however, data is limited describing the use and safety of liposomal amphotericin B (L-AMB). Methods: Records of patients receiving L-AMB OPAT between 1/1/2015 and 7/31/2018 were retrospectively reviewed. The primary objective was to describe the OPAT patient population discharged on L-AMB and evaluate factors associated with readmission and adverse events (AE). Analysis was performed to evaluate for predictors of worse outcomes. Results: Forty-two patients (67% male, median age 50 years) were identified, most commonly treated for histoplasmosis. The most common doses of L-AMB were 3 mg/kg (n=16, 38%) or 5 mg/kg (n=14, 33%) based on actual body weight. Twenty-six (62%) patients completed their anticipated course of L-AMB. Twenty-two (52%) patients were readmitted within 30 days of discharge, median time to readmission was 11 days (Interquartile range [IQR] 5-18). While hypokalemia and acute kidney injury (AKI) were common, occurring in 26 (62%) and 20 (48%), respectively, only 5 (12%) were readmitted to the hospital due L-AMB-associated AE. Ninety percent of patients achieved at least partial renal recovery within 30 days after L-AMB discontinuation. Factors significantly associated with AKI include higher L-AMB dose, lower serum potassium levels after therapy initiation, and receipt of potassium supplementation at discharge. Conclusion: L-AMB is associated with significant AEs; however, these results suggest treatment is feasible in the outpatient setting with close monitoring, as the majority of AEs were managed effectively as an outpatient without long-term sequelae.

scholarly journals 777. Experience with Liposomal Amphotericin B in Outpatient Parenteral Antimicrobial Therapy (OPAT)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S345-S345
Author(s):  
Yvonne Burnett ◽  
Yasir Hamad
Keyword(s):  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Univariate Analysis ◽  
Outpatient Setting ◽  
Primary Objective ◽  
Liposomal Amphotericin B ◽  
Close Monitoring ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Factors Associated ◽  
Jewish Hospital

Abstract Background While OPAT is known to be a safe, effective, and convenient treatment strategy for patients receiving intravenous antimicrobials in the outpatient setting, the risk of adverse events (AEs) increases when high-risk medications, such as liposomal amphotericin B (L-AMB), are utilized. There is limited data available describing the use and safety of L-AMB in the OPAT setting. Methods Electronic medical records of patients discharged from Barnes Jewish Hospital on L-AMB between January 2015 and July 2018 were retrospectively reviewed. The primary objective of this study was to describe the population of OPAT patients discharged on L-AMB and to evaluate factors associated with readmission and AEs. Univariate analysis was performed to evaluate for predictors of worse outcomes. Results Forty-two patients (67% male, median age 50 years) were identified. The most common indications were histoplasmosis (n = 13, 31%) and aspergillosis (n = 7, 17%). The majority of patients were discharged to home (n = 35, 83%) on a median dose of 4 mg/kg L-AMB. More than half of the patients completed their anticipated course of L-AMB (n = 26, 62%), 17 without any interruption or change in therapy, while 16/42 patients required early discontinuation of therapy, 11 of which required a change in therapy. Twenty-one patients (50%) were readmitted during their L-AMB course with a median time to readmission of 10 days (IQR 4–18). While hypokalemia and AKI (increase in serum creatinine by 0.5 mg/dL or 50% from baseline) were common AEs, occurring in 62% (n = 26) and 49% (n = 20), only 5 (12%) were readmitted to the hospital due L-AMB-associated AE (hypokalemia (K < 3 mEq/L), n = 2; AKI, n = 3. Factors associated with all-cause readmission included malignancy (not readmitted 6/21 vs. readmitted 13/21, P = 0.02) and duration of therapy (median of 15 vs. 32 days in not readmitted vs. readmitted, P = 0.02). OPAT lab monitoring was performed at a median of 2 times per week. No patients required hemodialysis due to AKI. Conclusion L-AMB is associated with significant AEs; however, these results suggest treatment is feasible in the outpatient setting with close monitoring. The majority of AEs were managed effectively as an outpatient without long-term sequelae. Disclosures All authors: No reported disclosures.

Risk Factors Associated With Nephrotoxicity During Outpatient Intravenous Vancomycin Administration

2021 ◽  
pp. 875512252110543
Author(s):  
Karen M. Krueger ◽  
Lisa LaCloche ◽  
Amy Buros Stein ◽  
Ryan Kates ◽  
Milena Murray ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Outpatient Setting ◽  
Intravenous Antibiotic ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Intravenous Antibiotics ◽  
Vancomycin Trough ◽  
Control Study

Background: Many studies have described an association between intravenous vancomycin and nephrotoxicity; however, the majority have evaluated incidence and risk factors among hospitalized patients. Outpatient administration of intravenous antibiotics is a growing practice and presents its own set of unique challenges. Objective: The aim of this study was to identify risk factors for vancomycin-associated nephrotoxicity in the outpatient setting. Methods: A case-control study of patients who received intravenous vancomycin through an Outpatient Parenteral Antimicrobial Therapy (OPAT) program was conducted. Patients were identified who developed an acute kidney injury (AKI) during treatment. The primary outcome was the incidence of AKI during treatment. Results: A total of 37 out of 130 patients (28.5%) met the criteria for AKI. AKI was more likely to occur in patients with a longer duration of therapy, higher maximum trough concentration, co-administration of a fluoroquinolone or metronidazole, and those who received another potentially nephrotoxic medication. Co-administration of a fluoroquinolone (OR = 5.96, P = 0.009, [CI: 1.59, 24.38]), any nephrotoxic medication (OR = 11.17, P < 0.001, [CI 3.14, 51.23]), and a higher maximum vancomycin trough (OR = 1.29, P < 0.001, [CI 1.17, 1.44]) were all indicative of a higher odds of an AKI. Conclusion: In this cohort, vancomycin-associated nephrotoxicity was common during outpatient intravenous antibiotic therapy. Co-administration of a fluoroquinolone, any nephrotoxic medication, and a higher maximum vancomycin trough were associated with AKI development. Further study is needed to determine how this impacts long-term clinical outcomes and what measures can be taken to reduce nephrotoxicity risk.

scholarly journals Renal Recovery following Liposomal Amphotericin B-Induced Nephrotoxicity

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Heather A. Personett ◽  
Bryce M. Kayhart ◽  
Erin F. Barreto ◽  
Pritish Tosh ◽  
Ross Dierkhising ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Renal Recovery ◽  
Cumulative Exposure ◽  
Liposomal Amphotericin B

Background. Acute kidney injury (AKI) is a common complication of treatment with liposomal amphotericin B (LAmB). The trajectory of renal recovery after LAmB-associated AKI has not been well described, nor has effect of LAmB dose on recovery of renal function been explored. Objective. Characterize the pattern of renal recovery after incident AKI during LAmB and determine potential influencing factors. Methods. This retrospective cohort study analyzed patients who developed a ≥50% increase in serum creatinine while on LAmB. Patients were followed up until complete renal recovery or death or for 30 days, whichever occurred first. The primary outcome was complete renal recovery, defined as serum creatinine convalescence to within 10% of the patient’s pretreatment baseline. Multivariable modeling was used to identify independent predictors of renal recovery. Results. Ninety-eight patients experienced nephrotoxicity during LAmB, 94% of which received doses <7 mg/kg/day. Fifty-one patients at least partially recovered renal function and, of these, 32 exhibited complete recovery after a mean 9.8 ± 7.8 days. No statistical relationship was found between LAmB dose at the time of AKI or cumulative exposure to LAmB and the likelihood of renal recovery. Concomitant nephrotoxins, age, and pretreatment renal function did not modify this effect in multivariable analysis. Conclusion and Relevance. Our data suggests that LAmB dose did not impact the likelihood of renal recovery. Additional investigation is needed to confirm these findings when aggressive dosing strategies are employe. Additional research is also warranted to further characterize the course of recovery after LAmB-associated nephrotoxicity and comprehensive spectrum of renal outcomes.

scholarly journals Five-Year Field Results and Long-Term Effectiveness of 20 mg/kg Liposomal Amphotericin B (Ambisome) for Visceral Leishmaniasis in Bihar, India

2014 ◽  
Vol 8 (1) ◽  
pp. e2603 ◽  
Author(s):  
Sakib Burza ◽  
Prabhat K. Sinha ◽  
Raman Mahajan ◽  
María Angeles Lima ◽  
Gaurab Mitra ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Liposomal Amphotericin B

scholarly journals Optimal management of acute kidney injury in critically ill patients with invasive fungal infections being treated with liposomal amphotericin B

2020 ◽  
Vol 13 (5) ◽  
pp. e233072 ◽  
Author(s):  
Darius Armstrong-James ◽  
Mickey Koh ◽  
Marlies Ostermann ◽  
Paul Cockwell
Keyword(s):  
Acute Kidney Injury ◽  
Amphotericin B ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Liposomal Amphotericin ◽  
Fungal Infections ◽  
Kidney Injury ◽  
Invasive Fungal Infections ◽  
Liposomal Amphotericin B ◽  
Cell Transplant

Critically ill patients are at risk of developing both acute kidney injury (AKI) and invasive fungal infections (IFIs). Prompt and efficient treatment of the IFI is essential for the survival of the patient. This article examines three distinct clinical situations where liposomal amphotericin B, a broad-spectrum antifungal agent, was successfully used in the setting of AKI. The first was Aspergillus infection in a 63-year-old man with bleeding oesophageal varices related to advanced liver disease. The second was gastrointestinal mucormycosis in a 74-year-old man who developed a small bowel obstruction following an autologous stem cell transplant for mantle cell lymphoma. The third was a Fusarium infection in a 32-year-old woman on immunosuppression for a bilateral lung transplant for cystic fibrosis. In all three cases, liposomal amphotericin B was required for urgent management of the patient’s IFI. We discuss the rationale for treatment with a potentially nephrotoxic agent in this setting.

scholarly journals Factor analysis of acute kidney injury in patients administered liposomal amphotericin B in a real-world clinical setting in Japan

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Takahiro Takazono ◽  
Masato Tashiro ◽  
Yuki Ota ◽  
Yoko Obata ◽  
Tomotaro Wakamura ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Fungal Infections ◽  
Angiotensin Receptor Blockers ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Fold Increase ◽  
Liposomal Amphotericin B ◽  
Converting Enzyme Inhibitors

Abstract Liposomal amphotericin B (L-AMB) is a broad-spectrum antifungal drug that is used to treat fungal infections. However, clinical evidence of its use in patients with renal failure is limited. Here, we aimed to identify factors associated with acute kidney injury (AKI) in patients administered L-AMB. We retrospectively utilized a combination of Diagnosis Procedure Combination data and laboratory data obtained from hospitals throughout Japan between April 2008 and January 2018. In total, 507 patients administered L-AMB were identified. After L-AMB treatment initiation, AKI, which was defined as a ≥ 1.5-fold increase within 7 days or ≥ 0.3 mg/dL increase within 2 days in serum creatinine according to the KDIGO criteria, was recognized in 37% of the total patients (189/507). The stages of AKI were stage 1 in 20%, stage 2 in 11%, and stage 3 in 7%. Five factors were associated with AKI of all stages: prior treatment with angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers or carbapenem; concomitant administration of catecholamines or immunosuppressants; and ≥ 3.52 mg/kg/day of L-AMB dosing. Serum potassium < 3.5 mEq/L before L-AMB therapy was associated with severe AKI of stage 2 and 3. Altogether, these factors should be carefully considered to reduce the occurrence of AKI in patients administered L-AMB.

scholarly journals Case-Control Study and Case Series of Pseudohyperphosphatemia during Exposure to Liposomal Amphotericin B

2015 ◽  
Vol 59 (11) ◽  
pp. 6816-6823 ◽  
Author(s):  
Nicole M. Bohm ◽  
Katherine C. Hoover ◽  
Amy E. Wahlquist ◽  
Yusheng Zhu ◽  
Juan Carlos Q. Velez
Keyword(s):  
Acute Kidney Injury ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Case Control Study ◽  
Case Series ◽  
Kidney Injury ◽  
Case Control ◽  
Liposomal Amphotericin B ◽  
Control Study ◽  
Phosphorus Levels

ABSTRACTPseudohyperphosphatemia due to an interaction between liposomal amphotericin B and the Beckman Coulter PHOSm assay occurs sporadically and remains underrecognized in clinical practice. This retrospective case-control study compares the incidences of hyperphosphatemia in adult inpatients exposed to liposomal amphotericin B or a triazole. A case series of patients with confirmed pseudohyperphosphatemia is described. A total of 80 exposures to liposomal amphotericin B and 726 exposures to triazoles were identified. Among subjects without chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia occurred more often during liposomal amphotericin B therapy than during triazole therapy (40% [14/35 cases] versus 10% [47/475 cases] of cases;P< 0.01; adjusted odds ratio, 5.2 [95% confidence interval {CI}, 2.3 to 11.9]). Among individuals with chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia also occurred more often during liposomal amphotericin B exposure (59% [10/17 cases] versus 20% [34/172 cases] of cases;P< 0.01; adjusted odds ratio, 6.0 [95% CI, 2.0 to 18.0]). When acute kidney injury occurred during antifungal exposure, the frequencies of hyperphosphatemia were not different between treatments. Seven episodes of unexpected hyperphosphatemia during liposomal amphotericin B exposure prompted a confirmatory test using an endpoint-based assay that found lower serum phosphorus levels (median difference of 2.5 mg/dl [range, 0.6 to 3.6 mg/dl]). Liposomal amphotericin B exposure confers a higher likelihood of developing hyperphosphatemia than that with exposure to a triazole antifungal, which is likely attributable to pseudohyperphosphatemia. Elevated phosphorus levels in patients receiving liposomal amphotericin B at institutions using the Beckman Coulter PHOSm assay should be interpreted cautiously.

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