Intensive Care Medicine

, Volume 35, Issue 5, pp 903–908

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

  • Laurence Senn
  • Philippe Eggimann
  • Riadh Ksontini
  • Andres Pascual
  • Nicolas Demartines
  • Jacques Bille
  • Thierry Calandra
  • Oscar Marchetti
Brief Report
  • 522 Downloads

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

Caspofungin Prevention Surgery Pancreatitis Candidiasis Fungal infection 

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Laurence Senn
    • 1
  • Philippe Eggimann
    • 2
  • Riadh Ksontini
    • 3
  • Andres Pascual
    • 1
  • Nicolas Demartines
    • 3
  • Jacques Bille
    • 1
    • 4
  • Thierry Calandra
    • 1
  • Oscar Marchetti
    • 1
  1. 1.Infectious Diseases Service, Department of MedicineCentre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL)LausanneSwitzerland
  2. 2.Adult Intensive Care ServiceCentre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL)LausanneSwitzerland
  3. 3.Visceral Surgery ServiceCentre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL)LausanneSwitzerland
  4. 4.Institute of MicrobiologyCentre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL)LausanneSwitzerland

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