Could liposomal amphotericin B (L-AMB) lock solutions be useful to inhibit Candida spp. biofilms on silicone biomaterials?

Abstract

L-AMB (1000 mg/L) lock solutions strongly inhibited Candida spp. in young and mature biofilms for up to 48 h after the end of the lock. However, overall eradication of the biofilm was not obtained using 1000 mg/L L-AMB as a single lock. These results suggest the usefulness of systemic treatment combined with an L-AMB lock to control Candida spp. biofilms associated with catheters.

Caspofungin at Catheter Lock Concentrations Eradicates Mature Biofilms of Candida lusitaniae and Candida guilliermondii

“…(P Ͻ 0.05). Similar to our results, Toulet et al (20) showed strong inhibition of C. albicans and Candida glabrata biofilms by LAMB without leading to complete eradication of biofilms.…”

Antifungal Lock Therapy

“…L-AMB (1 mg/ml) substantially, but not completely, inhibited biofilm metabolic activity. L-AMB (0.2 mg/ml) was the least effective, particularly with shorter lock times (Ͻ4 h) against mature, 5-day-old C. parapsilosis biofilms (32). The mechanism of enhanced activity of amphotericin B lipid formulations compared to d-AmB is unknown.…”

“…Although there are some reports of reduced susceptibility of C. parapsilosis to systemic echinocandins (55, 56), this effect was not generally observed with in vitro studies that included C. parapsilosis biofilms. One in vitro study utilizing a silicone disk model of Candida biofilms found that mature (5-dayold) C. parapsilosis biofilms were inhibited to a lesser extent than C. albicans or C. glabrata biofilms by high-dose L-AMB, although no biofilms were eradicated (32). Although reduced susceptibilities may be a concern in C. parapsilosis CR-BSIs, given the favorable outcomes in clinical studies and the high doses of antifungal drug utilized in AfLT, this approach should still be feasible.…”

Current recommendations and importance of antifungal stewardship for the management of invasive candidiasis

“…The ESCMID, JSMM and JMF guidelines recommend avoiding azoles when these devices cannot be removed and recommend echinocandins or liposomal amphotericin B instead. The usefulness of lock therapy with ethanol [97,98] or antifungal agents [99,100] has been suggested by a few reports, but the evidence has yet to reach a level that would allow this therapy to be strongly recommended for actual clinical practice.…”