Nebulized amphotericin B prophylaxis for Aspergillus infection in lung transplantation: study of risk factors.
BACKGROUND
Aspergillus infection remains a major cause of morbidity and mortality after lung transplantation. Therefore, some strategies have been attempted, one of which is nebulized amphotericin B (nAB); however, the efficacy of this prophylaxis has not been shown clearly. The aim is to study whether nAB can protect against Aspergillus infection in lung transplant recipients.


METHODS
A study of risk factors was conducted in 55 consecutive lung allograft recipients. Twenty-three potential risk factors were analyzed. In 44 (80%) patients, nAB was indicated as prophylaxis. Multivariate analysis using logistic regression was performed.


RESULTS
Eighteen of the 55 patients (33%) developed infection due to Aspergillus spp. Multivariate analysis showed nAB to be a preventive factor (odds ratio: 0.13; 95% confidence interval [CI] 0.02-0.69; p < 0.05) and cytomegalovirus (CMV) disease was an independent risk factor for developing Aspergillus infection (odds ratio: 5.1; 95% CI 1.35-19.17; p < 0.05). Only 1 patient required withdrawal of the prophylaxis owing to bronchospasm. nAB was well-tolerated in the remaining patients with only a few, mild, easily controlled side effects.


CONCLUSIONS
The present results show that nAB prophylaxis may be efficient and safe in preventing Aspergillus infection in lung-transplanted patients, and CMV disease increases the probability of Aspergillus infection.
Monforte
V
V
Servei de Pneumologia, Hospital General Vall d'Hebron, Barcelona, Spain.
Roman
A
A
Gavalda
J
J
Bravo
C
C
Tenorio
L
L
Ferrer
A
A
Maestre
J
J
Morell
F
F
D000293:Adolescent; D000328:Adult; D000336:Aerosols; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage* / Q000009:adverse effects; D001228:Aspergillosis / Q000276:immunology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000276:immunology / Q000517:prevention & control*; D016040:Lung Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D009894:Opportunistic Infections / Q000276:immunology / Q000517:prevention & control*; D012307:Risk Factors; D014181:Transplantation Immunology / Q000276:immunology; D016896:Treatment Outcome
D000336:Aerosols; D000666:Amphotericin B