title: Intraabdominal candidiasis in surgical ICU patients treated with anidulafungin: A multicenter retrospective study.
abstract: OBJECTIVE
  Patients with recent intraabdominal events are at uniquely risk for intraabdominal candidiasis (IAC). Candida peritonitis is a frequent and life-threatening complication in surgically ill patients. International guidelines do not specifically address IAC. This study describes clinical features of IAC in critical patients treated with anidulafungin in Surgical ICUs (SICUs).
  
  
  METHODS
  A practice-based retrospective study was performed including all adults with IAC admitted to 19 SICUs for ≥24h treated with anidulafungin. IAC was documented (Candida isolation from blood/peritoneal fluid/abscess fluid and/or histopathological confirmation) or presumptive (host factors plus clinical criteria without mycological support). Total population and the subgroup of septic shock patients were analyzed.
  
  
  RESULTS
  One hundred and thirty nine patients were included, 94 (67.6%) with septic shock, 112 (86.2%) after urgent surgery. Of them, 77.7% presented peritonitis and 21.6% only intraabdominal abscesses. Among 56.8% cases with documented IAC, C. albicans (52.8%) followed by C. glabrata (27.8%) were the most frequent species. Anidulafungin was primarily used as empirical therapy (59.7%), microbiologically directed (20.9%) and anticipated therapy (15.8%). Favourable response was 79.1% (76.6% among patients with septic shock). Intra-SICU mortality was 25.9% (28.7% among patients with septic shock).
  
  
  CONCLUSIONS
  Among IACs managed at SICUs, peritonitis was the main presentation, with high percentage of patients presenting septic shock. C. albicans followed by C. glabrata were the main responsible species. Anidulafungin treatment was mostly empirical followed by microbiologically directed therapy, with a favourable safety profile, even among patients with septic shock.
authors.affiliation: Emilio Maseda, Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain. emilio.maseda@gmail.com.
authors.forename: Emilio
authors.initials: E
authors.lastname: Maseda
authors.forename: Marta
authors.initials: M
authors.lastname: Rodríguez-Manzaneque
authors.forename: David
authors.initials: D
authors.lastname: Dominguez
authors.forename: Matilde
authors.initials: M
authors.lastname: González-Serrano
authors.forename: Lorena
authors.initials: L
authors.lastname: Mouriz
authors.forename: Julián
authors.initials: J
authors.lastname: Álvarez-Escudero
authors.forename: Nazario
authors.initials: N
authors.lastname: Ojeda
authors.forename: Purificación
authors.initials: P
authors.lastname: Sánchez-Zamora
authors.forename: Juan-José
authors.initials: JJ
authors.lastname: Granizo
authors.forename: María-José
authors.initials: MJ
authors.lastname: Giménez
mesh_terms: D000005:Abdomen / Q000601:surgery; D018784:Abdominal Abscess / Q000188:drug therapy / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077612:Anidulafungin; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002176:Candida albicans; D041221:Candida glabrata; D002177:Candidiasis / Q000188:drug therapy* / Q000453:epidemiology* / Q000601:surgery; D003422:Critical Care; D054714:Echinocandins / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000188:drug therapy / Q000209:etiology; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy / Q000209:etiology; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D000077612:Anidulafungin