Role of liposomal amphotericin B in intensive care unit: an expert opinion paper
Abstract Introduction Invasive fungal infections (IFI) are frequent in patients admitted to the intensive care unit (ICU). The use of first-line antifungals like triazoles or echinocandins may be limited by the global spread of multi-drug resistance species, drug–drug interactions, low organ penetra...
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BMC
2025-04-01
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| Series: | Journal of Anesthesia, Analgesia and Critical Care |
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| Online Access: | https://doi.org/10.1186/s44158-025-00236-z |
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| author | Linda Bussini Michele Bartoletti Matteo Bassetti Andrea Cortegiani Gennaro De Pascale Francesco Giuseppe De Rosa Marco Falcone Maddalena Giannella Massimo Girardis Paolo Grossi Malgorzata Mikulska Paolo Navalesi Federico Pea Maurizio Sanguinetti Carlo Tascini Bruno Viaggi Pierluigi Viale |
| author_facet | Linda Bussini Michele Bartoletti Matteo Bassetti Andrea Cortegiani Gennaro De Pascale Francesco Giuseppe De Rosa Marco Falcone Maddalena Giannella Massimo Girardis Paolo Grossi Malgorzata Mikulska Paolo Navalesi Federico Pea Maurizio Sanguinetti Carlo Tascini Bruno Viaggi Pierluigi Viale |
| author_sort | Linda Bussini |
| collection | DOAJ |
| description | Abstract Introduction Invasive fungal infections (IFI) are frequent in patients admitted to the intensive care unit (ICU). The use of first-line antifungals like triazoles or echinocandins may be limited by the global spread of multi-drug resistance species, drug–drug interactions, low organ penetration, and some safety concerns in case of multi-organ failure. Liposomal amphotericin B (L-AmB) is a polyene drug with a broad activity against mold and yeast and an acceptable safety profile. To outline the role of L-AmB in the treatment of IFI in critically ill patients, a panel of experts was invited to draw up an expert opinion paper on the appropriate place in therapy of L-AmB in different clinical scenarios of patients admitted to ICU. Methods A multidisciplinary group of 16 specialists in infectious disease, microbiology, pharmacology, and intensive care elaborated an expert opinion document through a multi-step approach: (1) the scientific panel defined the items and wrote the statements on the management of IFI in ICU, (2) a survey was submitted to an external panel to express agreement or disagreement on the statements, and (3) the panel reviewed the survey and implemented the final document. Results The final document included 35 statements that focused on epidemiology and microbiological rationale of the use of systemic L-AmB in critically ill patients and its potential role in specific clinical scenarios in the ICU. Conclusion Systemic L-AmB may represent an appropriate therapeutic choice for IFI in ICU patients with different underlying conditions, especially when the use of first-line agents is undermined. This expert opinion paper may provide a useful guide for clinicians. |
| format | Article |
| id | doaj-art-a0b079cabf3c48f0a80b7784afdd1cd7 |
| institution | Kabale University |
| issn | 2731-3786 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Anesthesia, Analgesia and Critical Care |
| spelling | doaj-art-a0b079cabf3c48f0a80b7784afdd1cd72025-08-20T03:52:19ZengBMCJournal of Anesthesia, Analgesia and Critical Care2731-37862025-04-015112310.1186/s44158-025-00236-zRole of liposomal amphotericin B in intensive care unit: an expert opinion paperLinda Bussini0Michele Bartoletti1Matteo Bassetti2Andrea Cortegiani3Gennaro De Pascale4Francesco Giuseppe De Rosa5Marco Falcone6Maddalena Giannella7Massimo Girardis8Paolo Grossi9Malgorzata Mikulska10Paolo Navalesi11Federico Pea12Maurizio Sanguinetti13Carlo Tascini14Bruno Viaggi15Pierluigi Viale16Infectious Diseases Unit, Hospital Health Direction, IRCCS Humanitas Research HospitalInfectious Diseases Unit, Hospital Health Direction, IRCCS Humanitas Research HospitalDivision of Infectious Diseases, IRCCS Ospedale Policlinico San MartinoDepartment of Precision Medicine in Medical Surgical and Critical Care, University of PalermoDepartment of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCSDepartment, of Medical Sciences, Infectious Diseases, University of TurinInfectious Disease Unit, AOU Pisana PO Cisanello, University of PisaDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of BolognaAnesthesia and Intensive Care Medicine, Policlinico Di Modena, University of Modena and Reggio EmiliaInfectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria - ASST-Sette LaghiDivision of Infectious Diseases, IRCCS Ospedale Policlinico San MartinoInstitute of Anesthesia and Intensive Care, University of PaduaDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of BolognaDepartment of Basic Biotechnological Sciences, Intensive and Perioperative Clinics, Catholic University of the Sacred HeartInfectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC)ICU Department, Careggi HospitalDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of BolognaAbstract Introduction Invasive fungal infections (IFI) are frequent in patients admitted to the intensive care unit (ICU). The use of first-line antifungals like triazoles or echinocandins may be limited by the global spread of multi-drug resistance species, drug–drug interactions, low organ penetration, and some safety concerns in case of multi-organ failure. Liposomal amphotericin B (L-AmB) is a polyene drug with a broad activity against mold and yeast and an acceptable safety profile. To outline the role of L-AmB in the treatment of IFI in critically ill patients, a panel of experts was invited to draw up an expert opinion paper on the appropriate place in therapy of L-AmB in different clinical scenarios of patients admitted to ICU. Methods A multidisciplinary group of 16 specialists in infectious disease, microbiology, pharmacology, and intensive care elaborated an expert opinion document through a multi-step approach: (1) the scientific panel defined the items and wrote the statements on the management of IFI in ICU, (2) a survey was submitted to an external panel to express agreement or disagreement on the statements, and (3) the panel reviewed the survey and implemented the final document. Results The final document included 35 statements that focused on epidemiology and microbiological rationale of the use of systemic L-AmB in critically ill patients and its potential role in specific clinical scenarios in the ICU. Conclusion Systemic L-AmB may represent an appropriate therapeutic choice for IFI in ICU patients with different underlying conditions, especially when the use of first-line agents is undermined. This expert opinion paper may provide a useful guide for clinicians.https://doi.org/10.1186/s44158-025-00236-zInvasive fungal infectionsIntensive care unitAntifungal therapyLiposomal amphotericin BCritically ill patientAspergillosis |
| spellingShingle | Linda Bussini Michele Bartoletti Matteo Bassetti Andrea Cortegiani Gennaro De Pascale Francesco Giuseppe De Rosa Marco Falcone Maddalena Giannella Massimo Girardis Paolo Grossi Malgorzata Mikulska Paolo Navalesi Federico Pea Maurizio Sanguinetti Carlo Tascini Bruno Viaggi Pierluigi Viale Role of liposomal amphotericin B in intensive care unit: an expert opinion paper Journal of Anesthesia, Analgesia and Critical Care Invasive fungal infections Intensive care unit Antifungal therapy Liposomal amphotericin B Critically ill patient Aspergillosis |
| title | Role of liposomal amphotericin B in intensive care unit: an expert opinion paper |
| title_full | Role of liposomal amphotericin B in intensive care unit: an expert opinion paper |
| title_fullStr | Role of liposomal amphotericin B in intensive care unit: an expert opinion paper |
| title_full_unstemmed | Role of liposomal amphotericin B in intensive care unit: an expert opinion paper |
| title_short | Role of liposomal amphotericin B in intensive care unit: an expert opinion paper |
| title_sort | role of liposomal amphotericin b in intensive care unit an expert opinion paper |
| topic | Invasive fungal infections Intensive care unit Antifungal therapy Liposomal amphotericin B Critically ill patient Aspergillosis |
| url | https://doi.org/10.1186/s44158-025-00236-z |
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