title: Caspofungin for prevention of intra-abdominal candidiasis in high-risk surgical patients.
abstract: OBJECTIVE
  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) > or =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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
authors.forename: Laurence
authors.initials: L
authors.lastname: Senn
authors.forename: Philippe
authors.initials: P
authors.lastname: Eggimann
authors.forename: Riadh
authors.initials: R
authors.lastname: Ksontini
authors.forename: Andres
authors.initials: A
authors.lastname: Pascual
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: Jacques
authors.initials: J
authors.lastname: Bille
authors.forename: Thierry
authors.initials: T
authors.lastname: Calandra
authors.forename: Oscar
authors.initials: O
authors.lastname: Marchetti
mesh_terms: D018784:Abdominal Abscess / Q000382:microbiology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000150:complications / Q000517:prevention & control*; D000077336:Caspofungin; D004334:Drug Administration Schedule; D054714:Echinocandins / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery; D007813:Laparotomy; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery; D011183:Postoperative Complications / Q000382:microbiology / Q000517:prevention & control; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin