Amphotericin B Nasal Spray Appears Effective in Preventing Breakthrough Fungal Infections in Colonized SCT Recipients

Fungal colonization may increase the risk for developing invasive fungal infections(IFI) for patients undergoing stem cell transplants (SCT). At Northwestern Memorial Hospital a protocol was initiated in 2005 to administer amphotericin B decanoate nasal spray to all SCT recipients with  fungal nasal colonization.

Amphotericin B 0.5% nasal spray was given twice daily in addition to systemic prophylaxis (fluconazole  for auto-SCT's  or voriconazole 200 mg  for allo-SCT's) to  all patients with nasal fungal colonization.  Nasal surveillance cultures were repeated within 7- 30 days of Ampho B initiation.  An independent expert reviewer was utilized to determine the presence of IFI according to EORTC criteria. 

Amongst 1936 patients reviewed, 117 fungal isolates (62 mould and 57  yeast ) were identified from the nares of  109 patients (78 auto/31 allo). There was no significant difference in age, gender, diagnosis, transplant or donor type between patients with and without nasal fungal colonization. Eight patients had a prior history of IFI.  Nasal surveillance cultures after Ampho B  began showed 100% eradication of all isolates.  One breakthrough IFI was observed amongst the 109 Ampho B treated patients (Alternia ssp.soft tissue infection in auto-SCT successfully treated with voriconazole).   Systemic Antifungal  prophylaxis  was changed in 25 patients, primarily for febrile neutropenia or liver enzyme abnormalities.  Nasal Ampho B was well tolerated and no patient discontinued use during transplantation.

Intranasal Ampho B  effectively  eradicates nasal fungal colonization and appears effective  in preventing breakthrough fungal infections in colonized HSCT recipients.  

 

Number of colonized patients(%)	109(5.6)
Total Isolates	117
Autologous	78(5.7)
Allogeneic (MDS)	14(5.4)
Allogeneic (MUD)	17(5)
Yeast (Non-speciated)	57
Alternaria	20
Penicillium	12
Aspergillus spp	11
Molds (Non-spp)	8
Cladosporium	3
Fusarium	2
Others	6
History of prior IFI	8
Change in systemic antifungal therapy	25
Eradication of nasal colonization(%)	100
Documented breakthrough IFI	1