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

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.

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

Scientific Reports ◽

10.1038/s41598-020-72135-y ◽

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.

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Invasive Fungal Infections While on Voriconazole, Liposomal Amphotericin B, or Micafungin for Antifungal Prophylaxis in Pediatric Stem Cell Transplant Patients

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-24.3.220 ◽

2019 ◽

Vol 24 (3) ◽

pp. 220-226

Author(s):

Annie Bui ◽

Veronica Nguyen ◽

Christina Hsu ◽

Ben Hyde ◽

Tiffany Simms-Waldrip

Keyword(s):

Stem Cell ◽

Amphotericin B ◽

Liposomal Amphotericin ◽

Stem Cell Transplant ◽

Fungal Infections ◽

Antifungal Prophylaxis ◽

Invasive Fungal Infections ◽

Liposomal Amphotericin B ◽

Cell Transplant ◽

Hematopoietic Stem

OBJECTIVE This study aimed to report the incidence of invasive fungal infections (IFIs) in pediatric hematopoietic stem cell transplant (HSCT) patients who received voriconazole, liposomal amphotericin B (L-AMB), or micafungin for primary antifungal prophylaxis (PAP). METHODS Using data retrospectively collected from institution's electronic records, this study analyzed the incidence of IFIs in pediatric HSCT patients between November 2012 and November 2016. RESULTS A total of 103 patients were screened. Of the 84 patients who met inclusion criteria, 76.2%, 29.8%, and 19% patients received voriconazole, L-AMB, and micafungin, respectively. The incidence of overall IFIs was 2.08 per 1000 prophylaxis days. There were 2 mold infections identified in 2 patients. Among 3 antifungal agents, the rates of IFIs were 2.67 per 1000 prophylaxis days in L-AMB group, 2.08 per 1000 prophylaxis days in micafungin group, and 1.17 per 1000 prophylaxis days in voriconazole group. CONCLUSION Patients who received L-AMB or micafungin had higher rates of IFIs than those who received voriconazole for PAP.

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