Antifungal prophylaxis with nebulized amphotericin-B in solid-organ transplant recipients with severe COVID-19: a retrospective observational study
COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as a frequent complication in the intensive care unit (ICU). However, little is known about this life-threatening fungal superinfection in solid organ transplant recipients (SOTRs), including whether targeted anti-mold prophylaxis might...
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-04-01
|
| Series: | Frontiers in Cellular and Infection Microbiology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcimb.2023.1165236/full |
| _version_ | 1797838651006124032 |
|---|---|
| author | Alexander Rombauts Marta Bodro Victor Daniel Gumucio Irene Carbonell Àlex Favà Laura Lladó José González-Costello Federico Oppenheimer María Ángeles Castel-Lavilla Oscar Len Oscar Len Oscar Len Ester Marquez-Algaba Ester Marquez-Algaba Xavier Nuvials-Casals Daniel Martínez González Judith Sacanell Lacasa Jordi Carratalà Jordi Carratalà Jordi Carratalà Nuría Sabé Nuría Sabé |
| author_facet | Alexander Rombauts Marta Bodro Victor Daniel Gumucio Irene Carbonell Àlex Favà Laura Lladó José González-Costello Federico Oppenheimer María Ángeles Castel-Lavilla Oscar Len Oscar Len Oscar Len Ester Marquez-Algaba Ester Marquez-Algaba Xavier Nuvials-Casals Daniel Martínez González Judith Sacanell Lacasa Jordi Carratalà Jordi Carratalà Jordi Carratalà Nuría Sabé Nuría Sabé |
| author_sort | Alexander Rombauts |
| collection | DOAJ |
| description | COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as a frequent complication in the intensive care unit (ICU). However, little is known about this life-threatening fungal superinfection in solid organ transplant recipients (SOTRs), including whether targeted anti-mold prophylaxis might be justified in this immunosuppressed population. We performed a multicentric observational retrospective study of all consecutive ICU-admitted COVID-19 SOTRs between August 1, 2020 and December 31, 2021. SOTRs receiving antifungal prophylaxis with nebulized amphotericin-B were compared with those without prophylaxis. CAPA was defined according the ECMM/ISHAM criteria. Sixty-four SOTRs were admitted to ICU for COVID-19 during the study period. One patient received antifungal prophylaxis with isavuconazole and was excluded from the analysis. Of the remaining 63 SOTRs, nineteen (30.2%) received anti-mold prophylaxis with nebulized amphotericin-B. Ten SOTRs who did not receive prophylaxis developed pulmonary mold infections (nine CAPA and one mucormycosis) compared with one who received nebulized amphotericin-B (22.7% vs 5.3%; risk ratio 0.23; 95%CI 0.032-1.68), but with no differences in survival. No severe adverse events related to nebulized amphotericin-B were recorded. SOTRs admitted to ICU with COVID-19 are at high risk for CAPA. However, nebulized amphotericin-B is safe and might reduce the incidence of CAPA in this high-risk population. A randomized clinical trial to confirm these findings is warranted. |
| first_indexed | 2024-04-09T15:44:17Z |
| format | Article |
| id | doaj.art-82e333f258c64d179827c5beac5d68ea |
| institution | Directory Open Access Journal |
| issn | 2235-2988 |
| language | English |
| last_indexed | 2024-04-09T15:44:17Z |
| publishDate | 2023-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cellular and Infection Microbiology |
| spelling | doaj.art-82e333f258c64d179827c5beac5d68ea2023-04-27T05:23:30ZengFrontiers Media S.A.Frontiers in Cellular and Infection Microbiology2235-29882023-04-011310.3389/fcimb.2023.11652361165236Antifungal prophylaxis with nebulized amphotericin-B in solid-organ transplant recipients with severe COVID-19: a retrospective observational studyAlexander Rombauts0Marta Bodro1Victor Daniel Gumucio2Irene Carbonell3Àlex Favà4Laura Lladó5José González-Costello6Federico Oppenheimer7María Ángeles Castel-Lavilla8Oscar Len9Oscar Len10Oscar Len11Ester Marquez-Algaba12Ester Marquez-Algaba13Xavier Nuvials-Casals14Daniel Martínez González15Judith Sacanell Lacasa16Jordi Carratalà17Jordi Carratalà18Jordi Carratalà19Nuría Sabé20Nuría Sabé21Department of Infectious Diseases, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, SpainDepartment of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona, SpainDepartment of Intensive Care Medicine, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, SpainDepartment of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona, SpainRenal Transplant Unit, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, SpainLiver Transplant Unit, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, SpainHeart Transplant Unit, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, SpainRenal Transplant Unit, Hospital Clínic de Barcelona, Barcelona, SpainHeart Transplant Unit, Hospital Clínic de Barcelona, Barcelona, SpainDepartment of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain0Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain1Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, SpainDepartment of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain0Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain2Department of Intensive Care Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain2Department of Intensive Care Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain2Department of Intensive Care Medicine, Hospital Universitari Vall d'Hebron, Barcelona, SpainDepartment of Infectious Diseases, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain1Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain3Bellvitge Biomedical Research Institute (IDIBELL), L´Hospitalet de Llobregat, Barcelona, SpainDepartment of Infectious Diseases, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain1Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, SpainCOVID-19-associated pulmonary aspergillosis (CAPA) has emerged as a frequent complication in the intensive care unit (ICU). However, little is known about this life-threatening fungal superinfection in solid organ transplant recipients (SOTRs), including whether targeted anti-mold prophylaxis might be justified in this immunosuppressed population. We performed a multicentric observational retrospective study of all consecutive ICU-admitted COVID-19 SOTRs between August 1, 2020 and December 31, 2021. SOTRs receiving antifungal prophylaxis with nebulized amphotericin-B were compared with those without prophylaxis. CAPA was defined according the ECMM/ISHAM criteria. Sixty-four SOTRs were admitted to ICU for COVID-19 during the study period. One patient received antifungal prophylaxis with isavuconazole and was excluded from the analysis. Of the remaining 63 SOTRs, nineteen (30.2%) received anti-mold prophylaxis with nebulized amphotericin-B. Ten SOTRs who did not receive prophylaxis developed pulmonary mold infections (nine CAPA and one mucormycosis) compared with one who received nebulized amphotericin-B (22.7% vs 5.3%; risk ratio 0.23; 95%CI 0.032-1.68), but with no differences in survival. No severe adverse events related to nebulized amphotericin-B were recorded. SOTRs admitted to ICU with COVID-19 are at high risk for CAPA. However, nebulized amphotericin-B is safe and might reduce the incidence of CAPA in this high-risk population. A randomized clinical trial to confirm these findings is warranted.https://www.frontiersin.org/articles/10.3389/fcimb.2023.1165236/fullCOVID-19SARS-CoV-2solid-organ transplant recipientsamphotericin-BprophylaxisAspergillus spp. |
| spellingShingle | Alexander Rombauts Marta Bodro Victor Daniel Gumucio Irene Carbonell Àlex Favà Laura Lladó José González-Costello Federico Oppenheimer María Ángeles Castel-Lavilla Oscar Len Oscar Len Oscar Len Ester Marquez-Algaba Ester Marquez-Algaba Xavier Nuvials-Casals Daniel Martínez González Judith Sacanell Lacasa Jordi Carratalà Jordi Carratalà Jordi Carratalà Nuría Sabé Nuría Sabé Antifungal prophylaxis with nebulized amphotericin-B in solid-organ transplant recipients with severe COVID-19: a retrospective observational study Frontiers in Cellular and Infection Microbiology COVID-19 SARS-CoV-2 solid-organ transplant recipients amphotericin-B prophylaxis Aspergillus spp. |
| title | Antifungal prophylaxis with nebulized amphotericin-B in solid-organ transplant recipients with severe COVID-19: a retrospective observational study |
| title_full | Antifungal prophylaxis with nebulized amphotericin-B in solid-organ transplant recipients with severe COVID-19: a retrospective observational study |
| title_fullStr | Antifungal prophylaxis with nebulized amphotericin-B in solid-organ transplant recipients with severe COVID-19: a retrospective observational study |
| title_full_unstemmed | Antifungal prophylaxis with nebulized amphotericin-B in solid-organ transplant recipients with severe COVID-19: a retrospective observational study |
| title_short | Antifungal prophylaxis with nebulized amphotericin-B in solid-organ transplant recipients with severe COVID-19: a retrospective observational study |
| title_sort | antifungal prophylaxis with nebulized amphotericin b in solid organ transplant recipients with severe covid 19 a retrospective observational study |
| topic | COVID-19 SARS-CoV-2 solid-organ transplant recipients amphotericin-B prophylaxis Aspergillus spp. |
| url | https://www.frontiersin.org/articles/10.3389/fcimb.2023.1165236/full |
| work_keys_str_mv | AT alexanderrombauts antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT martabodro antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT victordanielgumucio antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT irenecarbonell antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT alexfava antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT laurallado antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT josegonzalezcostello antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT federicooppenheimer antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT mariaangelescastellavilla antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT oscarlen antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT oscarlen antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT oscarlen antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT estermarquezalgaba antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT estermarquezalgaba antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT xaviernuvialscasals antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT danielmartinezgonzalez antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT judithsacanelllacasa antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT jordicarratala antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT jordicarratala antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT jordicarratala antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT nuriasabe antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy AT nuriasabe antifungalprophylaxiswithnebulizedamphotericinbinsolidorgantransplantrecipientswithseverecovid19aretrospectiveobservationalstudy |