Intensive Care Medicine

, Volume 35, Issue 5, pp 903–908

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

Authors

  • Laurence Senn
    • Infectious Diseases Service, Department of MedicineCentre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL)
  • Philippe Eggimann
    • Adult Intensive Care ServiceCentre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL)
  • Riadh Ksontini
    • Visceral Surgery ServiceCentre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL)
  • Andres Pascual
    • Infectious Diseases Service, Department of MedicineCentre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL)
  • Nicolas Demartines
    • Visceral Surgery ServiceCentre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL)
  • Jacques Bille
    • Infectious Diseases Service, Department of MedicineCentre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL)
    • Institute of MicrobiologyCentre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL)
  • Thierry Calandra
    • Infectious Diseases Service, Department of MedicineCentre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL)
    • Infectious Diseases Service, Department of MedicineCentre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL)
Brief Report

DOI: 10.1007/s00134-009-1405-8

Cite this article as:
Senn, L., Eggimann, P., Ksontini, R. et al. Intensive Care Med (2009) 35: 903. doi:10.1007/s00134-009-1405-8

Abstract

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) ≥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.

Keywords

CaspofunginPreventionSurgeryPancreatitisCandidiasisFungal infection

Copyright information

© Springer-Verlag 2009