A multicentre study of amphotericin B treatment for histoplasmosis: assessing mortality rates and adverse events.
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Sekiguchi William Kazunori, de Oliveira Vítor Falcão, Cavassin Francelise Bridi, Taborda Mariane, Gonçalves Kono Magri Adriana Satie, da Cruz Isabela Carvalho Leme Vieira, Vidal Jose Ernesto, Falci Diego Rodrigues, Silva de Miranda Godoy Cássia, de Bastos Ascenço Soares Renata, de Oliveira Carla Sakuma, Mendes Ana Verena Almeida, Breda Giovanni Luís, Rego Caroline Martins, Félix Maíra Araujo, Katopodis Paula Pacheco, da Silva do Ó Julia Raquel, Abrão Mirela Pereira Lima, Baú-Carneiro João Luiz, Pereira Talita Teles Teixeira, Queiroz-Telles Flávio, Mihailenko Chaves Magri Marcello
Аннотация
OBJECTIVES: Our objectives were to comprehensively describe histoplasmosis treatment with various amphotericin B (AmB) formulations, including mortality rates, adverse effects and risk factors for mortality.
METHODS: This multicentre retrospective cohort study (January 2014-December 2019) evaluated medical records of patients with proven or probable histoplasmosis treated with at least two doses of AmB in seven tertiary medical centres in Brazil. We assessed risk factors associated with death during hospitalization using univariate and multivariate analyses.
RESULTS: The study included 215 patients, mostly male (n = 158, 73%) with HIV infection (n = 187, 87%), and a median age of 40 years. Only 11 (5%) patients initiated treatment with liposomal amphotericin B (L-AmB). Amphotericin B deoxycholate (D-AmB) was administered to 159 (74%) patients without changes in the treatment. The overall mortality during hospitalization was 23% (50/215). Variables independently associated with mortality were use of D-AmB (OR 4.93) and hospitalization in ICU (OR 9.46). There was a high incidence of anaemia (n = 19, 90%), acute kidney injury (n = 96, 59%), hypokalaemia (n = 73, 55%) and infusion reactions (n = 44, 20%) during treatment.
CONCLUSIONS: We found that D-AmB was the main formulation, which was also associated with a higher mortality rate. Lipid formulations of AmB have become more readily available in the public health system in Brazil. Further studies to evaluate the effectiveness of L-AmB will likely show improvements in the treatment outcomes for patients with disseminated histoplasmosis.