Sullivan Kelly A, Caylor Meghan M, Lin Feng-Chang, Campbell-Bright Stacy
1 Neurointensive Care/Neurosurgery, Department of Pharmacy, University of North Carolina Hospitals, Chapel Hill, NC, USA.
2 Neurointensive Care, Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
J Pharm Pract. 2017 Jun;30(3):347-352. doi: 10.1177/0897190016645032. Epub 2016 Apr 24.
Funguria occurs often in hospitalized patients and is most commonly caused by Candida species. Fluconazole is the agent of choice for most Candida urinary tract infections. Amphotericin B bladder irrigations (ABBI) are an alternative treatment option.
The purpose of this study is to assess the efficacy of ABBI compared to fluconazole for the treatment of candiduria in the intensive care unit (ICU) setting.
We conducted a retrospective chart review of patients admitted to ICUs at our institution with a positive urine culture for Candida species between 2005 and 2012. All patients receiving ABBI were included; patients receiving fluconazole for treatment of candiduria were matched by year. The primary endpoint was achievement of cure.
There was no difference in cure between the ABBI and fluconazole groups (59.6% vs. 52.8%, p = 0.55). Clearance was higher in patients receiving ABBI (92.3% vs. 67.9%, p < 0.001). Logistic regression found that renal dysfunction predicted greater cure with ABBI therapy compared to fluconazole (OR 7.63, 95% CI 1.81-32.1).
ABBI was equally efficacious in achieving overall cure, and resulted in greater clearance of candiduria compared to fluconazole. ABBI may be considered an alternative to fluconazole for the treatment of candiduria and may be preferred over fluconazole in patients with renal dysfunction.
真菌尿症在住院患者中经常出现，最常见的病因是念珠菌属。氟康唑是大多数念珠菌性尿路感染的首选药物。两性霉素B膀胱灌注（ABBI）是一种替代治疗选择。
本研究的目的是评估在重症监护病房（ICU）环境中，与氟康唑相比，ABBI治疗念珠菌尿症的疗效。
我们对2005年至2012年间在我院ICU住院且尿培养念珠菌属阳性的患者进行了回顾性病历审查。纳入所有接受ABBI治疗的患者；接受氟康唑治疗念珠菌尿症的患者按年份进行匹配。主要终点是达到治愈。
ABBI组和氟康唑组的治愈率无差异（59.6%对52.8%，p = 0.55）。接受ABBI治疗的患者清除率更高（92.3%对67.9%，p < 0.001）。逻辑回归发现，与氟康唑相比，肾功能不全患者接受ABBI治疗的治愈率更高（OR 7.63，95%CI 1.81 - 32.1）。
ABBI在实现总体治愈方面同样有效，与氟康唑相比，ABBI能使念珠菌尿清除率更高。ABBI可被视为治疗念珠菌尿症的氟康唑替代方案，对于肾功能不全患者可能比氟康唑更具优势。
