title: Effectiveness of liposomal amphotericin B in patients admitted to the ICU on renal replacement therapy.
abstract: BACKGROUND
  This study was designed to compare the effectiveness of liposomal amphotericin B (L-AmB) in ICU patients with and without renal replacement therapy (RRT).
  
  
  METHODS
  Observational, retrospective, comparative and multicenter study conducted in critically ill patients treated with L-AmB for 3 or more days, divided into two cohorts depending on the use of RRT before or within the first 48 hours after starting L-AmB. Clinical and microbiological response at the end of treatment was evaluated.
  
  
  RESULTS
  A total of 158 patients met the inclusion criteria, 36 (22.8%) of which required RRT during the ICU stay. Patients with RRT as compared with those without RRT showed a higher APACHE II score on admission (21.4 vs 18.4, P = 0.041), greater systemic response against infection (P = 0.047) and higher need of supportive techniques (P = 0.002). In both groups, main reasons for the use of L-AmB were broad spectrum and hemodynamic instability. A higher daily dose of L-AmB was used in the RRT group (4.30 vs 3.84 mg/kg, P = 0.030) without differences in the total cumulative dose or treatment duration. There were no differences in the clinical response (61.1% vs 56.6%, P = 0.953) or microbiological eradication rate (74.1% vs 64.6%, P = 0.382). In patients with proven invasive fungal infection, satisfactory clinical response was obtained in 74.1% and microbiological eradication 85.7%.
  
  
  CONCLUSIONS
  Although the study sample is small, this study shows that L-AmB is effective in critically ill patients admitted to the ICU requiring RRT.
authors.affiliation: F. Álvarez-Lerma, Service of Intensive Care Medicine, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, E-08003 Barcelona, Spain. 16839@parcdesalutmar.cat.
authors.forename: Francisco
authors.initials: F
authors.lastname: Álvarez-Lerma
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rodriguez
authors.forename: Mari Cruz
authors.initials: MC
authors.lastname: Soriano
authors.forename: Mercedes
authors.initials: M
authors.lastname: Catalán
authors.forename: Ana María
authors.initials: AM
authors.lastname: Llorente
authors.forename: Nieves
authors.initials: N
authors.lastname: Vidart
authors.forename: María
authors.initials: M
authors.lastname: Garitacelaya
authors.forename: Enrique
authors.initials: E
authors.lastname: Maravi
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Fernández Rey
authors.forename: Francisco
authors.initials: F
authors.lastname: Alvarado
authors.forename: Marta
authors.initials: M
authors.lastname: López-Sánchez
authors.forename: Bernabé
authors.initials: B
authors.lastname: Alvarez-Sánchez
authors.forename: David
authors.initials: D
authors.lastname: Granado
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Quintana
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000517:prevention & control; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D007674:Kidney Diseases / Q000382:microbiology / Q000628:therapy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000379:methods* / Q000401:mortality; D013030:Spain; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B