Peghin Maddalena, Monforte Victor, Martin-Gomez Maria-Teresa, Ruiz-Camps Isabel, Berastegui Cristina, Saez Berta, Riera Jordi, Ussetti Piedad, Solé Juan, Gavaldá Joan, Roman Antonio
Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
Transpl Int. 2016 Jan;29(1):51-62. doi: 10.1111/tri.12679. Epub 2015 Oct 12.
The aim of this study was to assess the outcome and tolerability of prophylactic nebulized liposomal amphotericin B (n-LAB) in lung transplant recipients (LTR) and the changing epidemiology of Aspergillus spp. infection and colonization. We performed an observational study including consecutive LTR recipients (2003-2013) undergoing n-LAB prophylaxis lifetime. A total of 412 patients were included (mean postoperative follow-up 2.56 years; IQR 1.01-4.65). Fifty-three (12.8%) patients developed 59 Aspergillus spp. infections, and 22 invasive aspergillosis (overall incidence 5.3%). Since 2009, person-time incidence rates of Aspergillus spp. colonization and infection decreased (2003-2008, 0.19; 2009-2014, 0.09; P = 0.0007), but species with reduced susceptibility or resistance to amphotericin significantly increased (2003-2008, 38.1% vs 2009-2014, 58.1%; P = 0.039). Chronic lung allograft dysfunction (CLAD) was associated with Aspergillus spp. colonization and infection (HR 24.4, 95% CI 14.28-41.97; P = 0.00). Only 2.9% of patients presented adverse effects, and 1.7% required discontinuation. Long-term administration of prophylaxis with n-LAB has proved to be tolerable and can be used for preventing Aspergillus spp. infection in LTR. Over the last years, the incidence of Aspergillus spp. colonization and infection has decreased, but species with reduced amphotericin susceptibility or resistance are emerging. CLAD is associated with Aspergillus spp. colonization and infection.
本研究的目的是评估预防性雾化脂质体两性霉素B（n-LAB）在肺移植受者（LTR）中的疗效和耐受性，以及曲霉属感染和定植的流行病学变化。我们进行了一项观察性研究，纳入了2003年至2013年期间接受终身n-LAB预防的连续LTR受者。共纳入412例患者（术后平均随访2.56年；四分位间距1.01 - 4.65）。53例（12.8%）患者发生了59例曲霉属感染，22例侵袭性曲霉病（总发病率5.3%）。自2009年以来，曲霉属定植和感染的人时发病率下降（2003 - 2008年，0.19；2009 - 2014年，0.09；P = 0.0007），但对两性霉素敏感性降低或耐药的菌种显著增加（2003 - 2008年，38.1% vs 2009 - 2014年，58.1%；P = 0.039）。慢性肺移植功能障碍（CLAD）与曲霉属定植和感染相关（风险比24.4，95%置信区间14.28 - 41.97；P = 0.00）。仅2.9%的患者出现不良反应，1.7%的患者需要停药。长期使用n-LAB预防已被证明是可耐受的，可用于预防LTR中的曲霉属感染。在过去几年中，曲霉属定植和感染的发病率有所下降，但对两性霉素敏感性降低或耐药的菌种正在出现。CLAD与曲霉属定植和感染相关。
