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

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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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Acknowledgments

We are thankful to Noémie Calandra, Isabel Cobos, Christian Durussel, Monika Ochsner, Annie Savoie, Aline Wenger, and the staffs of the Laboratories of Mycology and Serology of the Institute of Microbiology and of the Adult Intensive Care and Visceral Surgery Services for the outstanding assistance in collection and management of clinical data and blood samples. The study was supported by an unrestricted research grant of Merck, Sharp and Dohme-Chibret. The sponsor was neither involved in designing and running of the study, in data collection, analysis and interpretation, nor in redaction of the manuscript.

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Authors and Affiliations

  1. Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Laurence Senn, Andres Pascual, Jacques Bille, Thierry Calandra & Oscar Marchetti

  2. Adult Intensive Care Service, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland

    Philippe Eggimann

  3. Visceral Surgery Service, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland

    Riadh Ksontini & Nicolas Demartines

  4. Institute of Microbiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland

    Jacques Bille

Authors
  1. Laurence Senn
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  2. Philippe Eggimann
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  3. Riadh Ksontini
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  4. Andres Pascual
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  5. Nicolas Demartines
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  6. Jacques Bille
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  7. Thierry Calandra
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  8. Oscar Marchetti
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Corresponding author

Correspondence to Oscar Marchetti.

Additional information

This study has been partially presented as poster # M-1163 at the 47th ICAAC (Interscience Conference on Antimicrobial Agents and Chemotherapy), Chicago, 17–20 September 2007.

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Senn, L., Eggimann, P., Ksontini, R. et al. Caspofungin for prevention of intra-abdominal candidiasis in high-risk surgical patients. Intensive Care Med 35, 903–908 (2009). https://doi.org/10.1007/s00134-009-1405-8

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  • DOI: https://doi.org/10.1007/s00134-009-1405-8

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