Management of cerebral azole-resistant A. fumigatus infection. A role for intraventricular liposomal-amphotericin B?

Management of cerebral azole-resistant A. fumigatus infection. A role for intraventricular liposomal-amphotericin B?

J Glob Antimicrob Resist. 2020 Apr 03;:

Authors: Schauwvlieghe AFAD, Bredius RGM, Verdijk RM, Smiers FJW, van der Beek MT, Goemans BF, Zwaan CM, Brüggemann RJ, Rijnders BJA

Abstract
OBJECTIVES: In the pre-azole era, central nervous system (CNS) infections with Aspergillus had a dismal outcome. Survival improved with voriconazole but CNS infections caused by azole-resistant A. fumigatus is precluding its use. Intravenous liposomal-amphotericin B (L-AmB) is the preferred treatment option for azole-resistant CNS infections but has suboptimal brain concentrations.
METHODS: We describe three patients with biopsy proven CNS aspergillosis where intraventricular L-AmB is added to systemic therapy. 2 patients with azole-resistant and 1 patient with azole-susceptible CNS aspergillosis were treated with intraventricular L-AmB at a dose of 1 mg weekly.
RESULTS: We describe 3 patients successfully treated with a combination of intravenous and intraventricular L-AmB. All three patients survived but one patient has serious headache, most likely not related to this treatment.
CONCLUSIONS: Intraventricular L-AmB may have a role in the treatment of therapy-refractory CNS aspergillosis when added to systemic therapy.

PMID: 32251868 [PubMed – as supplied by publisher]

Source: Industry