900. Differences in Nephrotoxicity as Measured by Serum Creatinine among Inpatients Treated with Liposomal Amphotericin B or Amphotericin B Lipid Complex
Session: Poster Abstract Session: Antifungal Therapy
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AMB) have exhibited lower nephrotoxicity compared to conventional amphotericin B deoxycholate (CAB) in controlled trials. Previous studies suggest differences in nephrotoxicity between ABLC and L-AMB. This observational study examined rates of nephrotoxicity among adults with invasive fungal infections treated with ABLC or L-AMB.

Methods: The Health Facts® database (Cerner Corp, Kansas City, MO) with data from 141 regionally diverse hospitals was used to identify inpatients ≥18 years who received ABLC or L-AMB from 1/1/01-6/30/10.  Patients met criteria that precluded therapy with CAB, such as evidence of renal insufficiency, certain comorbidities, and/or evidence of a CAB-refractory infection.  Patients had a positive blood culture or diagnosis of Aspergillus, Candida, and/or Cryptococcus. Patients with >1 amphotericin B agent during the encounter were excluded.  The primary endpoint of nephrotoxicity was measured by change in serum creatinine (SCr) from pre to post ABLC or L-AMB treatment. Hospital length of stay (LOS) was defined as discharge date/time minus admission date/time (incl. emergency department [ED] time).  Univariate analyses were used for descriptive results.

Results: The cohort included 270 ABLC patients (47% male, mean age 55.2 [SD 19.0] y) and 140 L-AMB patients (59% male, 50.7 [18.5] y). Median post-amphotericin B LOS was 11.1 d (mean 16.1 [20.6] d) for ABLC versus 9.7 d for L-AMB (mean 16.2 [17.3] d, p=NS).  ABLC patients were more likely to be admitted from the ED or have an urgent/emergent admission type (73% v. 49%, p<0.001).  Among patients with pre and post SCr values, 13% of L-AMB patients (15 of 115) had a doubling of SCr versus 25% of ABLC patients (53 of 209, p=0.009).  The mean pre to post % SCr change was lower for L-AMB compared to ABLC (43% v. 75%, p=0.009), and fewer L-AMB patients had a peak SCr >2.0 mg/dL (29% v. 41%, p=0.026).

Conclusion: In this retrospective study of inpatients treated for an invasive fungal infection, L-AMB demonstrated a lower rate of nephrotoxicity compared to ABLC as measured by SCr. The clinical consequences of nephrotoxicity should be considered when selecting an amphotericin B agent for invasive fungal infections.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Rolin Wade, RPh, MS1, Paresh Chaudhari, PharmD2, Jaime Natoli, MS, MPH1, Robert Taylor3, Brian Nathanson, PhD4, Smita Kothari, PhD, MBA, RPh2 and David Horn, MD5, (1)Cerner LifeSciences, Beverly Hills, CA, (2)Astellas Pharma US, Inc., Deerfield, IL, (3)Cerner Corporation, Lansdale, PA, (4)OptiStatim, LLC, Longmeadow, MA, (5)David Horn, MD, Doylestown, PA

Disclosures:

R. Wade, Astellas Pharma, US: Consultant, Consulting fee
Cerner LifeSciences: Employee and Shareholder, Salary

P. Chaudhari, Astellas Pharma, US: Employee, Salary

J. Natoli, Astellas Pharma, US: Consultant, Consulting fee
Cerner LifeSciences: Employee and Shareholder, Salary

R. Taylor, Astellas Pharma, US: Consultant, Consulting fee
Cerner Corporation: Employee and Shareholder, Salary

B. Nathanson, Cerner Corporation: Consultant, Consulting fee

S. Kothari, Astellas Pharma, US: Employee, Salary

D. Horn, Astellas Pharma, US: Consultant, Consulting fee

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