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Open Access 26-03-2024 | Amphotericin B | Research

Use of nebulized liposomal amphotericin B and posaconazole as antifungal prophylaxis in patients with severe SARS-CoV2 infection in intensive care unit

Authors: Benedetta Fumarola, Liana Signorini, Silvia Lorenzotti, Paola Lanza, Barbara Saccani, Evelyn Van Hauwermeiren, Alice Mulè, Simone Piva, Matteo Rota, Francesco Zuccalà, Francesco Antonio Rasulo, Matteo Filippini, Alberto Bertazzoli, Giovanni Del Fabro, Alberto Matteelli

Published in: Infection | Issue 4/2024

Abstract

Purpose

COVID-19 associated pulmonary aspergillosis (CAPA) is common and linked with high fatality rates. To assess the impact on the incidence and outcome of CAPA of an antifungal prophylaxis (AFP) we compared two cohorts of COVID-19 patients admitted to intensive care units (ICU) in Brescia, Italy, from January to August 2021.

Methods

The study cohort included all mechanically ventilated patients observed between April 2021 and August 2021 with SARS-CoV-2-pneumonia, who received AFP with oral posaconazole (200 mg every 6 h) and nebulized liposomal amphotericin B (50 mg every 2 weeks) from ICU admission to 7 days after discharge or, if applicable, until tracheostomy removal. The control cohort included COVID-19 patients admitted to the same ICU between January and March 2021 who did not receive any AFP. Subjects with CAPA at ICU admission were excluded.

Results

We included 270 patients, of whom 64 (23.7%) received AFP. In patients in the study group, CAPA-related mortality was significantly reduced (29% vs. 48% p = 0.04), as well as the incidence of CAPA (3.1% vs 12.1%, p = 0.03). Patients who developed CAPA were older (mean of 70-y-old vs 63-y-old, p < 0.001). One subject discontinued posaconazole due to an adverse reaction. Among the 46 patients who received it, only one patient reached an effective plasma concentration of posaconazole.

Conclusion

AFP was associated with reduced incidence and mortality from CAPA and was well tolerated in patients with severe COVID-19. Posaconazole concentrations below the efficacy threshold in almost all patients may be attributable to drug interactions and prompt further studies to define its clinical significance.

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Title: Use of nebulized liposomal amphotericin B and posaconazole as antifungal prophylaxis in patients with severe SARS-CoV2 infection in intensive care unit
Authors: Benedetta Fumarola
Liana Signorini
Silvia Lorenzotti
Paola Lanza
Barbara Saccani
Evelyn Van Hauwermeiren
Alice Mulè
Simone Piva
Matteo Rota
Francesco Zuccalà
Francesco Antonio Rasulo
Matteo Filippini
Alberto Bertazzoli
Giovanni Del Fabro
Alberto Matteelli
Publication date: 26-03-2024
Publisher: Springer Berlin Heidelberg
Keywords: Amphotericin B
COVID-19
Aspergillosis
Published in: Infection / Issue 4/2024
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI: https://doi.org/10.1007/s15010-024-02234-9

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Use of nebulized liposomal amphotericin B and posaconazole as antifungal prophylaxis in patients with severe SARS-CoV2 infection in intensive care unit

Abstract

Purpose

Methods

Results

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