Clinical use of amphotericin B in patients with malignant hematological diseases combined with invasive fungal disease

Abstract:

Objective To analyze the clinical use of amphotericin B in hospitalized patients with malignant hematological diseases combined with invasive fungal disease (IFD) in Chinese PLA General Hospital, and provide basis for guiding rational clinical use of drugs. Methods From January to December 2021, hospitalized patients with malignant hematological diseases complicated with IFD and treated with amphotericin B in the Hematology Department and Hematopoietic Stem Cell Transplantation Ward of Chinese PLA General Hospital were selected as studied objects, and their demographic characteristics, imaging examination, fungal laboratory examination, usage and dosage of amphotericin B were analyzed. Results A total of 131 patients were enrolled, 26 cases (19.85%)were clinically diagnosed IFD, 52 cases (39.69%)were suspected, and 53 cases (40.46%)were undetermined. 28.57% (34/119) patients had positive (1, 3)-beta-D-glucan assay, 13.45% (16/119) had positive Galactomannan test, and 44.64% (50/112) had positive fungal culture. A total of 64 strains of fungi were cultured, most were Candida spp. (n=55) Usage and dosage of amphotericin B: 111 cases (84.73%) were treated with amphotericin B deoxycholate (d-AmB), 61 (46.56%) were treated by intravenous drip, 13 (9.92%) were treated with 0.9% sodium chloride injection as solvent, and 55 (41.98%) were treated with dexamethasone sodium phosphate before treatment. 109 patients (83.21%) were treated with antifungal combination regimen, most were d-AmB combined with voriconazole. The drug utilization index (DUI) value of d-AmB for intravenous drip and atomization inhalation were both < 1.00, and the DUI value of amphotericin B liposome (L-AmB) for intravenous drip was 1.04. Conclusion Amphotericin B is rationally used in this hospital, and the choice of solvent needs to be improved in order to obtain higher clinical benefits.

Key words:amphotericin B;invasive fungal disease;hematological disease;rational drug use