Efficacy of early administration of liposomal amphotericin B in patients with septic shock: A nationwide observational study. Issue 10 (October 2021)

• Record Type: Journal Article
• Authors: Tashiro, Masato; Takazono, Takahiro; Ota, Yuki; Wakamura, Tomotaro; Takahashi, Akinori; Sato, Kumiko; Miyazaki, Taiga; Obata, Yoko; Nishino, Tomoya; Izumikawa, Koichi
• Is Part Of: Journal of infection and chemotherapy. Volume 27:Issue 10(2021)
• Page Start: 1471
• Page End: 1476
• Publication Date: 2021-10
• Subjects: Liposomal amphotericin B -- Mortality -- Septic shock -- Early administration -- Observational study; APACHE acute physiology and chronic health evaluation -- AVE average -- CCI Charlson comorbidity index -- CI confidence interval -- CV central venous -- DPC diagnosis procedure combination -- G-CSF granulocyte-colony stimulating factor -- ICD-10 the International Classification of Diseases 10th Revision -- ICU intensive care unit -- IFI invasive fungal infection -- L-AMB liposomal-amphotericin B -- NA not analyzed -- RRT renal replacement therapy -- SD standard deviation -- SOFA sequential organ failure assessment; Chemotherapy -- Periodicals; Infection -- Periodicals; Communicable diseases -- Chemotherapy -- Periodicals; 615.5805
• DOI: 10.1016/j.jiac.2021.06.013
• Languages: English
• ISSNs: 1341-321X

Abstract

Abstract: Introduction: Liposomal amphotericin B (L-AMB), a broad spectrum anti-fungicidal drug, is often administered to treat invasive fungal infections (IFIs). However, the most suitable time to initiate treatment in septic shock patients with IFI is unknown. Methods: Patients with septic shock treated with L-AMB were identified from the Japanese Diagnosis Procedure Combination national database and were stratified according to L-AMB treatment initiation either at septic shock onset (early L-AMB group) or after the onset (delayed L-AMB group) to determine their survival rates following septic shock onset and the shock cessation period. Results: We identified 141 patients administered L-AMB on the day of or after septic shock onset: 60 patients received early treatment, whereas 81 patients received delayed treatment. Survival rates after septic shock onset were higher in the early L-AMB group than in the delayed L-AMB group (4 weeks: 68.4% vs 57.9%, P = 0.197; 6 weeks: 62.2% vs 44.5%, P = 0.061; 12 weeks: 43.4% vs 35.0%, P = 0.168, respectively). The septic shock cessation period was shorter in the early L-AMB group than in the delayed L-AMB group (7.0 ± 7.0 days vs 16.5 ± 15.4 days, P < 0.001), with a significant difference confirmed after adjusting for confounding factors with propensity score matching (7.1 ± 7.2 days vs 16.7 ± 14.0 days, P = 0.001). Conclusion: Early L-AMB administration at septic shock onset may be associated with early shock cessation.