Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany.
Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany.
Transpl Infect Dis. 2021 Aug;23(4):e13675. doi: 10.1111/tid.13675. Epub 2021 Jul 14.
Posaconazole and itraconazole are commonly used for systemic antifungal prophylaxis after lung transplantation. The aim of this study on critically ill lung transplant recipients was to assess the rate of adequate plasma concentrations and the frequency of fungal-induced transitions from antifungal prophylaxis to therapy after the administration of either posaconazole or itraconazole for systemic prophylaxis.
Critically ill lung transplant recipients with postoperative posaconazole or itraconazole prophylaxis and therapeutic drug monitoring from February 2016 to November 2019 were retrospectively included in the study. Positive fungal cultures or Aspergillus antigen tests resulting in a transition from antifungal prophylaxis to therapy were analyzed from the first day of prophylaxis until 7 days after the last sample for each patient. Adequate plasma concentrations were defined as ≥500 µg/L for itraconazole and ≥700 µg/L for posaconazole.
Two hundred seventy-five samples from 73 patients were included in the analysis. Overall, 60% of the posaconazole and 55% of the itraconazole concentrations were subtherapeutic. Administration of posaconazole suspension resulted significantly (P < .01) more often in subtherapeutic concentrations than tablets (68% vs 10%). Patients treated with posaconazole showed less positive fungal records resulting in a transition from prophylaxis to therapy than patients treated with itraconazole (10% vs 33%, P-value: .029). The detection of a fungal pathogen was not associated with the measured plasma concentrations or the achievement of the target concentrations.
Our findings suggest that posaconazole should be used instead of itraconazole for systemic prophylaxis in critically ill lung transplant recipients.
泊沙康唑和伊曲康唑常用于肺移植后的全身抗真菌预防。本研究旨在评估危重症肺移植受者在接受泊沙康唑或伊曲康唑全身预防治疗后，其血浆浓度达到充分水平的比例，以及真菌引起的从预防治疗转为治疗的频率。
回顾性纳入 2016 年 2 月至 2019 年 11 月接受术后泊沙康唑或伊曲康唑预防治疗和治疗药物监测的危重症肺移植受者。分析从每位患者的第一天预防治疗开始至最后一次样本后 7 天，阳性真菌培养或曲霉菌抗原检测导致从预防治疗转为治疗的情况。将伊曲康唑≥500μg/L 和泊沙康唑≥700μg/L 定义为充分的血浆浓度。
纳入 73 例患者的 275 个样本进行分析。总体而言，60%的泊沙康唑和 55%的伊曲康唑浓度低于治疗范围。泊沙康唑混悬液的给药导致低于治疗范围的浓度的比例明显高于片剂（68%比 10%）（P<.01）。与接受伊曲康唑治疗的患者相比，接受泊沙康唑治疗的患者的阳性真菌记录较少，导致从预防治疗转为治疗（10%比 33%，P 值：.029）。真菌病原体的检测与测量的血浆浓度或达到目标浓度无关。
我们的研究结果表明，在危重症肺移植受者中，应使用泊沙康唑替代伊曲康唑进行全身预防治疗。
