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Intensive Care Medicine
Published in: Intensive Care Medicine 5/2009

01-05-2009 | Brief Report

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

Authors: Laurence Senn, Philippe Eggimann, Riadh Ksontini, Andres Pascual, Nicolas Demartines, Jacques Bille, Thierry Calandra, Oscar Marchetti

Published in: Intensive Care Medicine | Issue 5/2009

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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.
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Metadata
Title
Caspofungin for prevention of intra-abdominal candidiasis in high-risk surgical patients
Authors
Laurence Senn
Philippe Eggimann
Riadh Ksontini
Andres Pascual
Nicolas Demartines
Jacques Bille
Thierry Calandra
Oscar Marchetti
Publication date
01-05-2009
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 5/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-009-1405-8

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