title: [Echinocandins in a critically ill patient during continuous venovenous renal replacement].
abstract: BACKGROUND
  Critically ill patients with invasive candidiasis (IC) often suffer renal failure, which sometimes requires continuous renal replacement techniques (CRRT). Echinocandins are the first line treatment for IC in critically ill patients with mild or severe illness. Their elimination during CRRT should be negligible due to their pharmacokinetic and pharmacodynamic (PK/PD) profile, and dose adjustment are not needed, as suggested by the few reported clinical studies.
  
  
  METHODS
  This is the case of a 66 year old male who underwent surgery due to peritonitis secondary to intestinal suture dehiscence. The patient was admitted to ICU with septic shock symptoms and multiple organ dysfunction syndrome (MODS), and CRRT was started. Anidulafungin was prescribed at the usual dosage due to the IC risk factors present, and the observation of yeasts in the peritoneal fluid. Anidulafungin was selected due to the hepatic failure suffered by the patient. An isolate of Candida albicans susceptible to fluconazole was cultured from peritoneal fluid and rectal exudates. However, anidulafungin was maintained due to the MODS and observing the clearance of fluconazole during CRRT. The patient's condition improved favourably, being moved to the surgical ward 20 days after the surgery.
  
  
  CONCLUSIONS
  Echinocandins, due to their PK/PD profile, could be safely given at usual doses to critically ill patients undergoing CRRT. However, new studies are required to strengthen this recommendation. Its extrahepatic metabolism makes anidulafungin a more attractive option among echinocandins and other antifungals when used in patients with different degrees of hepatic failure.
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Aguilar
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Carbonell
authors.forename: Carlos
authors.initials: C
authors.lastname: Ferrando
authors.forename: Rafael
authors.initials: R
authors.lastname: Badenes
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Belda
mesh_terms: D000368:Aged; D058365:Candidiasis, Invasive / Q000188:drug therapy*; D016638:Critical Illness; D054714:Echinocandins / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D017582:Renal Replacement Therapy / Q000379:methods
chemical_list: D054714:Echinocandins