A research agenda on the management of intra-abdominal candidiasis: results from a consensus of multinational experts.

MedStar author(s):
Citation: Intensive Care Medicine. 39(12):2092-106, 2013 Dec.PMID: 24105327Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Consensus Development Conference | Journal Article | Practice GuidelineSubject headings: *Antifungal Agents/tu [Therapeutic Use] | *Candidiasis/dt [Drug Therapy] | *Intraabdominal Infections/dt [Drug Therapy] | Abdominal Abscess/dt [Drug Therapy] | Abdominal Abscess/mi [Microbiology] | Adult | Bacteriological Techniques | Candida/ip [Isolation & Purification] | Candidiasis/mi [Microbiology] | DNA, Fungal/an [Analysis] | Humans | Intraabdominal Infections/mi [Microbiology] | Mycological Typing Techniques | Peritoneal Diseases/dt [Drug Therapy] | Peritoneal Diseases/mi [Microbiology] | Polymerase Chain Reaction | Risk FactorsYear: 2013Local holdings: Available online from MWHC library: 1997 - present, Available in print through MWHC library:2002-2007ISSN:
  • 0342-4642
Name of journal: Intensive care medicineAbstract: CONCLUSIONS: Specific recommendations were elaborated on IAC management based on the best direct and indirect evidence and on the expertise of a multinational panel.INTRODUCTION: intra-abdominal candidiasis (IAC) may include Candida involvement of peritoneum or intra-abdominal abscess and is burdened by high morbidity and mortality rates in surgical patients. Unfortunately, international guidelines do not specifically address this particular clinical setting due to heterogeneity of definitions and scant direct evidence. In order to cover this unmet clinical need, the Italian Society of Intensive Care and the International Society of Chemotherapy endorsed a project aimed at producing practice recommendations for the management of immune-competent adult patients with IAC.METHODS: A multidisciplinary expert panel of 22 members (surgeons, infectious disease and intensive care physicians) was convened and assisted by a methodologist between April 2012 and May 2013. Evidence supporting each statement was graded according to the European Society of Clinical Microbiology and Infection Diseases (ESCMID) grading system.RESULTS: Only a few of the numerous recommendations can be summarized in the Abstract. Direct microscopy examination for yeast detection from purulent and necrotic intra-abdominal specimens during surgery or by percutaneous aspiration is recommended in all patients with nonappendicular abdominal infections including secondary and tertiary peritonitis. Samples obtained from drainage tubes are not valuable except for evaluation of colonization. Prophylactic usage of fluconazole should be adopted in patients with recent abdominal surgery and recurrent gastrointestinal perforation or anastomotic leakage. Empirical antifungal treatment with echinocandins or lipid formulations of amphotericin B should be strongly considered in critically ill patients or those with previous exposure to azoles and suspected intra-abdominal infection with at least one specific risk factor for Candida infection. In patients with nonspecific risk factors, a positive mannan/antimannan or (1->3)-beta-D-glucan (BDG) or polymerase chain reaction (PCR) test result should be present to start empirical therapy. Fluconazole can be adopted for the empirical and targeted therapy of non-critically ill patients without previous exposure to azoles unless they are known to be colonized with a Candida strain with reduced susceptibility to azoles. Treatment can be simplified by stepping down to an azole (fluconazole or voriconazole) after at least 5-7 days of treatment with echinocandins or lipid formulations of amphotericin B, if the species is susceptible and the patient has clinically improved.All authors: Andoniadou A, Bassetti M, Chakrabarti A, Colizza S, Cristini F, De Rosa FG, Eckmann C, Garnacho-Montero J, Kett DH, Leroy O, Marchetti M, Menichetti F, Munoz P, Petrikos G, Righi E, Rocca GD, Roilides E, Sganga G, Shorr AF, Tascini C, Tumbarello M, Viale P, Viscoli C, Walsh TJFiscal year: FY2014Digital Object Identifier: Date added to catalog: 2014-08-21
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 24105327 Available 24105327

Available online from MWHC library: 1997 - present, Available in print through MWHC library:2002-2007

CONCLUSIONS: Specific recommendations were elaborated on IAC management based on the best direct and indirect evidence and on the expertise of a multinational panel.

INTRODUCTION: intra-abdominal candidiasis (IAC) may include Candida involvement of peritoneum or intra-abdominal abscess and is burdened by high morbidity and mortality rates in surgical patients. Unfortunately, international guidelines do not specifically address this particular clinical setting due to heterogeneity of definitions and scant direct evidence. In order to cover this unmet clinical need, the Italian Society of Intensive Care and the International Society of Chemotherapy endorsed a project aimed at producing practice recommendations for the management of immune-competent adult patients with IAC.

METHODS: A multidisciplinary expert panel of 22 members (surgeons, infectious disease and intensive care physicians) was convened and assisted by a methodologist between April 2012 and May 2013. Evidence supporting each statement was graded according to the European Society of Clinical Microbiology and Infection Diseases (ESCMID) grading system.

RESULTS: Only a few of the numerous recommendations can be summarized in the Abstract. Direct microscopy examination for yeast detection from purulent and necrotic intra-abdominal specimens during surgery or by percutaneous aspiration is recommended in all patients with nonappendicular abdominal infections including secondary and tertiary peritonitis. Samples obtained from drainage tubes are not valuable except for evaluation of colonization. Prophylactic usage of fluconazole should be adopted in patients with recent abdominal surgery and recurrent gastrointestinal perforation or anastomotic leakage. Empirical antifungal treatment with echinocandins or lipid formulations of amphotericin B should be strongly considered in critically ill patients or those with previous exposure to azoles and suspected intra-abdominal infection with at least one specific risk factor for Candida infection. In patients with nonspecific risk factors, a positive mannan/antimannan or (1->3)-beta-D-glucan (BDG) or polymerase chain reaction (PCR) test result should be present to start empirical therapy. Fluconazole can be adopted for the empirical and targeted therapy of non-critically ill patients without previous exposure to azoles unless they are known to be colonized with a Candida strain with reduced susceptibility to azoles. Treatment can be simplified by stepping down to an azole (fluconazole or voriconazole) after at least 5-7 days of treatment with echinocandins or lipid formulations of amphotericin B, if the species is susceptible and the patient has clinically improved.

English

Powered by Koha