Caspofungin for prevention of intra-abdominal candidiasis in high-risk surgical patients.

Détails

ID Serval
serval:BIB_C56A3484A9F2
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Caspofungin for prevention of intra-abdominal candidiasis in high-risk surgical patients.
Périodique
Intensive Care Medicine
Auteur(s)
Senn L., Eggimann P., Ksontini R., Pascual A., Demartines N., Bille J., Calandra T., Marchetti O.
ISSN
0342-4642
Statut éditorial
Publié
Date de publication
2009
Peer-reviewed
Oui
Volume
35
Numéro
5
Pages
903-908
Langue
anglais
Résumé
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.
Mots-clé
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
Pubmed
Web of science
Création de la notice
02/02/2009 11:25
Dernière modification de la notice
03/03/2018 21:15
Données d'usage