Deoxycholate amphotericin for management of mucormycosis: a retrospective cohort study from South India.

Q2 Medicine Infezioni in Medicina Pub Date : 2022-09-01 eCollection Date: 2022-01-01 DOI:10.53854/liim-3003-12
Nitin Gupta, Sourabh Srinivas, Anagha Harikumar, K Devaraja, Vishnu Teja Nallapati, Kavitha Saravu
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引用次数: 2

Abstract

Introduction: Liposomal amphotericin use is limited in developing countries due to its extremely high cost and availability. Therefore, the study aimed to evaluate deoxycholate amphotericin B's utility and adverse effect profile in patients with mucormycosis.

Methodology: This retrospective cohort study from 2019 to 2021 included patients with proven mucormycosis who received deoxycholate amphotericin B for more than or equal to five days and had at least three creatinine values on treatment. Baseline demographic details, risk factors and treatment details of all the patients were recorded. In addition, the details of treatment-related adverse effects and outcomes were ascertained.

Results: Of the 57 included patients, a history of diabetes, COVID-19 and steroid use was present in 49 (86%), 43 (75.4%) and 33 (57.9%) patients, respectively. Isolated rhino-orbital mucormycosis was the most common presentation (n=49, 86%). The median time of follow-up was 48 (30.5-90) days. A total of 8 (14%) patients died during the hospital stay. The median duration of amphotericin treatment was 21 (14-40) days. Thirty-nine patients (68.4%) developed hypokalaemia on treatment, while 27 (47.4%) patients developed hypomagnesaemia. A total of 34 (59.6%) patients developed AKI on treatment. The median day of development of AKI was 6 (4-10) days. The median baseline, highest and final creatinine values were 0.78 (0.59-0.94) mg/dl, 1.27 (0.89-2.16) mg/dl and 0.93 (0.74-1.59) mg/ dl respectively. The median percentage change from baseline to highest value and last follow-up value was 45% (0.43%-161%) and 25% (-4.8%-90.1%) respectively. The final creatinine was less than 150% of the baseline in 36 (63.2%) patients.

Conclusion: Deoxycholate amphotericin is an acceptable alternative for treating mucormycosis in resource-constrained settings.

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脱氧胆酸两性霉素治疗毛霉病:一项来自南印度的回顾性队列研究。
在发展中国家,由于其成本和可得性极高,脂质体两性霉素的使用受到限制。因此,本研究旨在评估脱氧胆酸两性霉素B在毛霉病患者中的效用和不良反应。方法:这项2019年至2021年的回顾性队列研究纳入了已证实的毛霉病患者,这些患者接受脱氧胆酸两性霉素B治疗超过或等于5天,治疗时肌酐值至少为3。记录所有患者的基线人口统计细节、危险因素和治疗细节。此外,还确定了治疗相关不良反应和结果的细节。结果:在纳入的57例患者中,分别有49例(86%)、43例(75.4%)和33例(57.9%)存在糖尿病史、COVID-19史和类固醇使用史。孤立性鼻眶毛霉菌病是最常见的表现(n= 49,86%)。中位随访时间为48(30.5-90)天。共有8例(14%)患者在住院期间死亡。两性霉素治疗的中位持续时间为21(14-40)天。治疗后出现低钾血症39例(68.4%),低镁血症27例(47.4%)。共有34例(59.6%)患者在治疗过程中发生AKI。AKI发展的中位天数为6(4-10)天。中位基线、最高和最终肌酐值分别为0.78 (0.59-0.94)mg/dl、1.27 (0.89-2.16)mg/dl和0.93 (0.74-1.59)mg/dl。从基线到最高值和末次随访值的中位百分比变化分别为45%(0.43%-161%)和25%(-4.8%-90.1%)。36例(63.2%)患者的最终肌酐值低于基线的150%。结论:脱氧胆酸两性霉素是一种可接受的替代治疗毛霉病在资源有限的设置。
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来源期刊
Infezioni in Medicina
Infezioni in Medicina Medicine-Infectious Diseases
CiteScore
8.40
自引率
0.00%
发文量
62
期刊介绍: The Journal publishes original papers, in Italian or in English, on topics concerning aetiopathogenesis, prevention, epidemiology, diagnosis, clinical features and therapy of infections, whose acceptance is subject to the referee’s assessment. The Journal is of interest not only to infectious disease specialists, microbiologists and pharmacologists, but also to internal medicine specialists, paediatricians, pneumologists, and to surgeons as well. The Editorial Board includes experts in each of the above mentioned fields.
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