PMID- 33846129
OWN - NLM
STAT- MEDLINE
DCOM- 20210618
LR  - 20211119
IS  - 1098-6596 (Electronic)
IS  - 0066-4804 (Print)
IS  - 0066-4804 (Linking)
VI  - 65
IP  - 6
DP  - 2021 May 18
TI  - Experience with Liposomal Amphotericin B in Outpatient Parenteral Antimicrobial 
      Therapy.
LID - 10.1128/AAC.01876-20 [doi]
LID - e01876-20
AB  - Outpatient parenteral antimicrobial therapy (OPAT) is a safe, effective, and 
      convenient treatment strategy for patients receiving intravenous antimicrobials 
      in the outpatient setting; however, data are limited describing the use and 
      safety of liposomal amphotericin B (L-AMB). Records of patients receiving L-AMB 
      OPAT between 1/1/2015 and 7/31/2018 were retrospectively reviewed. The primary 
      objective was to describe the OPAT patient population discharged on L-AMB and 
      evaluate factors associated with readmission and adverse events (AEs). Analysis 
      was performed to evaluate for predictors of worse outcomes. Forty-two patients 
      (67% male, median age 50 years) were identified, most of whom were treated for 
      histoplasmosis. The most common doses of L-AMB were 3 mg/kg (n = 16, 38%) or 
      5 mg/kg (n = 14, 33%) based on actual body weight. Twenty-six (62%) patients 
      completed their anticipated course of L-AMB. Twenty-two (52%) patients were 
      readmitted within 30 days of discharge; median time to readmission was 11 days 
      (interquartile range [IQR] 5 to 18). While hypokalemia and acute kidney injury 
      (AKI) were common, occurring in 26 (62%) and 20 (48%) patients, respectively, 
      only 5 (12%) were readmitted to the hospital due to L-AMB-associated AEs. Ninety 
      percent of patients achieved at least partial renal recovery within 30 days after 
      L-AMB discontinuation. Factors significantly associated with AKI include higher 
      L-AMB dose, lower serum potassium levels after therapy initiation, and receipt of 
      potassium supplementation at discharge. L-AMB is associated with significant AEs; 
      however, these results suggest that treatment is feasible in the outpatient 
      setting with close monitoring, as the majority of AEs were managed effectively in 
      an outpatient without long-term sequelae.
CI  - Copyright (c) 2021 American Society for Microbiology.
FAU - Burnett, Yvonne J
AU  - Burnett YJ
AUID- ORCID: 0000-0003-1114-3421
AD  - Department of Pharmacy Practice, St. Louis College of Pharmacy at the University 
      of Health Sciences and Pharmacy in St. Louis, St. Louis, Missouri, USA 
      Yvonne.burnett@uhsp.edu.
AD  - Division of Infectious Diseases, Washington University School of Medicine in St. 
      Louis, St. Louis, Missouri, USA.
FAU - Spec, Andrej
AU  - Spec A
AUID- ORCID: 0000-0001-7612-4710
AD  - Division of Infectious Diseases, Washington University School of Medicine in St. 
      Louis, St. Louis, Missouri, USA.
FAU - Ahmed, Mohamed M
AU  - Ahmed MM
AD  - Department of Nephrology, Medical University of South Carolina, Charleston, South 
      Carolina, USA.
FAU - Powderly, William G
AU  - Powderly WG
AD  - Division of Infectious Diseases, Washington University School of Medicine in St. 
      Louis, St. Louis, Missouri, USA.
FAU - Hamad, Yasir
AU  - Hamad Y
AUID- ORCID: 0000-0001-6616-7127
AD  - Division of Infectious Diseases, Washington University School of Medicine in St. 
      Louis, St. Louis, Missouri, USA.
LA  - eng
PT  - Journal Article
DEP - 20210518
PL  - United States
TA  - Antimicrob Agents Chemother
JT  - Antimicrobial agents and chemotherapy
JID - 0315061
RN  - 0 (Anti-Infective Agents)
RN  - 0 (Antifungal Agents)
RN  - 0 (liposomal amphotericin B)
RN  - 7XU7A7DROE (Amphotericin B)
SB  - IM
MH  - Amphotericin B
MH  - *Anti-Infective Agents
MH  - Antifungal Agents/adverse effects
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Outpatients
MH  - Retrospective Studies
PMC - PMC8316037
OTO - NOTNLM
OT  - OPAT
OT  - amphotericin
OT  - hypokalemia
OT  - nephrotoxicity
OT  - outpatient
EDAT- 2021/04/14 06:00
MHDA- 2021/06/22 06:00
PMCR- 2021/11/18
CRDT- 2021/04/13 05:48
PHST- 2020/09/04 00:00 [received]
PHST- 2021/03/21 00:00 [accepted]
PHST- 2021/04/14 06:00 [pubmed]
PHST- 2021/06/22 06:00 [medline]
PHST- 2021/04/13 05:48 [entrez]
PHST- 2021/11/18 00:00 [pmc-release]
AID - AAC.01876-20 [pii]
AID - 01876-20 [pii]
AID - 10.1128/AAC.01876-20 [doi]
PST - epublish
SO  - Antimicrob Agents Chemother. 2021 May 18;65(6):e01876-20. doi: 
      10.1128/AAC.01876-20. Print 2021 May 18.