Caspofungin for prevention of intra-abdominal candidiasis in high-risk surgical patients.
Data(s) |
2009
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Resumo |
PURPOSE: Thirty to forty percent of patients with recurrent gastrointestinal perforation/anastomotic leakage or acute necrotizing pancreatitis develop intra-abdominal invasive candidiasis (IC). A corrected Candida colonization index (CCI) > or =0.4 is a powerful predictor of IC. Fluconazole prevents intra-abdominal IC in this setting, but azole-resistant Candida species are emerging. The aim of this study was to explore the efficacy and safety of caspofungin for prevention of intra-abdominal IC in high-risk surgical patients. METHODS: Prospective non-comparative single-center study in consecutive adult surgical patients with recurrent gastrointestinal perforation/anastomotic leakage or acute necrotizing pancreatitis. Preventive caspofungin therapy (70 mg, then 50 mg/day) was given until resolution of the surgical condition. Candida colonization index and CCI, occurrence of intra-abdominal IC and adverse events were monitored. RESULTS: Nineteen patients were studied: 16 (84%) had recurrent gastrointestinal perforation/anastomotic leakage and 3 (16%) acute necrotizing pancreatitis. The median duration of preventive caspofungin therapy was 16 days (range 4-46). The colonization index decreased significantly during study therapy, and the CCI remained <0.4 in all patients. Caspofungin was successful for prevention of intra-abdominal IC in 18/19 patients (95%, 1 breakthrough IC 5 days after inclusion). No drug-related adverse event requiring caspofungin discontinuation occurred. CONCLUSION: Caspofungin may be efficacious and safe for prevention of intra-abdominal candidiasis in high-risk surgical patients. This needs to be further investigated in randomized trials. |
Identificador |
http://serval.unil.ch/?id=serval:BIB_C56A3484A9F2 isbn:0342-4642 pmid:19172247 doi:10.1007/s00134-009-1405-8 isiid:000265706900018 |
Idioma(s) |
en |
Fonte |
Intensive Care Medicine, vol. 35, no. 5, pp. 903-908 |
Palavras-Chave | #Abdominal Abscess/microbiology; Abdominal Abscess/prevention & control; Adult; Aged; Aged, 80 and over; Antifungal Agents/therapeutic use; Candidiasis/complications; Candidiasis/prevention & control; Drug Administration Schedule; Echinocandins/therapeutic use; Female; Humans; Intestinal Perforation/surgery; Laparotomy; Male; Middle Aged; Pancreatitis, Acute Necrotizing/surgery; Postoperative Complications/microbiology; Postoperative Complications/prevention & control; Prospective Studies; Surgical Wound Infection/microbiology; Surgical Wound Infection/prevention & control |
Tipo |
info:eu-repo/semantics/article article |