1433. Safety and Efficacy of Intravenous Voriconazole for Invasive Aspergillosis in Patients with Impaired Renal Function
Session: Poster Abstract Session: Fungal Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C

Background: Critically ill patients with invasive aspergillosis (IA) often have comorbidities such as renal insufficiency. In this clinical situation, intravenous (IV) voriconazole is not recommended because of the theoretical concern of the accumulation of sulfobutylether beta-cyclodextrin that is used for the carrier of IV formulation. However, there are limited data on this theoretical nephrotoxicity in human. We thus compared the safety and efficacy of IV voriconazole with oral voriconazole as initial therapy for IA in patients with renal insufficiency by a retrospective cohort study using propensity score to adjust for confounding by treatment assignment and a matched case-control study.

Methods: All adult patients with initial renal insufficiency (creatinine clearance [CCR] < 50 mL/min) who received oral or IV voriconazole for at least 1 week for IA treatment were enrolled at a transplant center during a 4-year period. Nephrotoxicity was defined as an increase of at least > 2 times the initial creatinine level or starting renal replacement therapy during voriconazole treatment. We used different and complementary approaches: (i) a retrospective cohort study using a propensity score analysis and (ii) a matched case-control study.

Results: Sixty-three patients with renal insufficiency, including 9 (14%) confirmed, 27 (43%) probable, and 27 (43%) possible IA, were analyzed. Of these 63 patients, 39 (62%) received IV voriconazole, and the remaining 24 (38%) received oral voriconazole. The detailed data for clinical characteristics and outcomes between the two groups are shown in Table. In the cohort study, nephrotoxicity rate was 3% (1/39) for IV group and 8% (2/24) for oral group (P = 0.55). All-cause mortality was 49% (19/39) in IV group compared to 17% (4/24) in oral group (P = 0.01). However, logistic regression model with propensity score revealed that IV voriconazole use was not associated with mortality (P = 0.19). In the case-control study, nephrotoxicity in IV voriconazole was 0% (0/14) and in oral voriconazole 7% (1/14) (P > 0.99). All-cause mortality in the IV group was 29% (4/14) versus 21% (3/14) in the oral group (P = 0.99).

Conclusion: Our study suggests that intravenous voriconazole use in patients with renal insufficiency appears to be safe compared with oral voriconazole use.

So-Youn Park, MD, Hyo-Lim Hong, MD, Sang-Oh Lee, MD, Sang-Ho Choi, MD, Yang Soo Kim, MD, Jun Hee Woo, MD, PhD and Sung-Han Kim, MD, Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea


S. Y. Park, None

H. L. Hong, None

S. O. Lee, None

S. H. Choi, None

Y. S. Kim, None

J. H. Woo, None

S. H. Kim, None

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