PLAYFORD EG, WEBSTER AC, CRAIG JC, SORRELL TC; Interscience Conference on Antimicrobial Agents and Chemotherapy (43rd: 2003: Chicago, Ill.).

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2003 Sep 14-17; 43: abstract no. M-968.

Princess Alexandra Hosp., Brisbane, Australia.

BACKGROUND: Invasive fungal infections (IFIs) cause considerable morbidity and mortality in solid organ transplant patients. We performed a systematic review of the benefits and harms of antifungal prophylaxis. METHODS: The Cochrane Controlled Trials Register, MEDLINE, EMBASE, conference abstracts and references were searched for randomized controlled trials (RCTs) (total 2771). RCTs were assessed for eligibility, quality and results by 2 reviewers. Data were meta-anlaysed using the random effects model and expressed as relative risk and 95% confidence intervals. RESULTS: Eleven RCTs (1254 pts) were included. In liver transplants, fluconazole (Fluc) (4 RCT: 640 pts), itraconazole (Itra) (2 RCT: 202 pts) or AmBisome (1 RCT) were compared with no systemic antifungal and 2 directly compared different agents. In renal transplants, ketoconazole (Keto) (3 RCT: 253 pts) was compared with no antifungal. Heterogeneity was not demonstrated for any comparison. Fluc reduced early proven IFIs (0.28, 0.13-0.57), proven/possible IFIs (0.46, 0.28-0.76) and fungal colonization (0.47, 0.37-0.61), but not mortality (0.98, 0.53-1.82). Fluc did not increase IFI (0.58, 0.14-2.36) or colonization (1.82, 0.66-5.03) with C. glabrata or C. krusei. No significant reduction in early proven IFIs (0.74, 0.42-1.31 and 1.3, 0.08-20.42 respectively) or mortality (0.67, 0.19-2.34 and 1.5, 0.18-12.87) was demonstrated with Itra or Keto. Adverse effects requiring drug cessation were no more common for any agent than control. Direct comparisons between agents did not show significant differences. CONCLUSIONS: In liver transplantation, Fluc significantly reduces early IFIs with no mortality benefit. Assuming 10% risk of IFI, 14 pts (12-24) require Fluc prophylaxis to prevent 1 IFI. No increase in Fluc-resistant candida species was demonstrated. Less data are available for other agents/transplants, however as pooled estimates are homogeneous, a benefit for other agents is not excluded.

Publication Types:

• Meeting Abstracts

Keywords:

• AmBisome
• Amphotericin B
• Antifungal Agents
• Clinical Trials as Topic
• Fluconazole
• Humans
• Itraconazole
• Ketoconazole
• Kidney Transplantation
• Liver Transplantation
• Meta-Analysis
• Mycoses
• Randomized Controlled Trials as Topic
• mortality
• surgery
• transplantation

Other ID:

• GWAIDS0025242

UI: 102264866

From Meeting Abstracts