[Candida peritonitis in a haemodynamically stable patient. First choice of antifungal treatment … fluconazole?]

Candida peritonitis in postoperative patients is an independent predictor of mortality. Empirical early antifungal therapy should be started in these patients, since according to the results of studies in patients with candidemia, this has an impact on the prognosis. The treatment recommended by clinical practice guidelines in patients with haemodynamic instability are candins, but they do not make explicit recommendations for patients with dysfunction of other organs, or high lactate levels.

A case of rescue treatment with anidulafungin in a patient with candidemia and Candida glabrata peritonitis postoperative haemodynamically stable, but with an acute renal failure and elevated plasma lactate, is reported. We discuss the antifungal treatment recommendations established by clinical practice guidelines.

One conclusion based on this case is that the haemodynamic instability as a marker of severe sepsis must be equated with dysfunction of any organ and/or a plasma lactate level ≥ 2.5 mmol/l in order to advocate candins as an antifungal treatment. In addition, it should be emphasised that anidulafungin was effective in a clinically difficult patient with candidemia and Candida peritonitis, even when used as late rescue antifungal treatment.