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Penetration of Isavuconazole in Ascites Fluid of Critically Ill Patients

Tobias Lahmer1, Gonzalo Batres Baires1, Roland M Schmid1

  • 1Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstrasse 22, 81675 Munich, Germany.

Journal of Fungi (Basel, Switzerland)
|June 2, 2021
PubMed

Insights

Isavuconazole, an antifungal, penetrates ascites fluid in critically ill patients with fungal peritonitis. Treatment success for Candida infections depends on pathogen susceptibility and drug levels.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Critical Care Medicine

Background:

  • Fungal peritonitis is a severe condition with challenging diagnosis and treatment.
  • Echinocandins and azoles are recommended for intra-abdominal Candida infections, with echinocandins preferred for critically ill patients.
  • Isavuconazole, a broad-spectrum triazole, shows promise, but data on its penetration into target sites like ascites are limited.

Purpose of the Study:

  • To evaluate isavuconazole concentrations and penetration ratios in the ascites fluid of critically ill patients.
  • To assess the potential of isavuconazole for treating fungal peritonitis.

Main Methods:

  • Isavuconazole plasma and ascites fluid levels were measured in sixteen critically ill patients using liquid chromatography/tandem mass spectrometry (LC-MS/MS).
  • Ascites fluid was obtained via paracentesis.
  • Penetration ratios were calculated based on plasma and ascites concentrations.

Main Results:

  • Isavuconazole concentrations in ascites fluid (1.06 µg/mL) were lower than in plasma (3.08 µg/mL), with a penetration ratio of 36%.
  • Candida spp. (C. glabrata, C. tropicalis) were isolated in two patients.
  • High Cmax/MIC ratios in plasma were observed for the isolated Candida species.

Conclusions:

  • Isavuconazole demonstrates penetration into the ascites fluid of critically ill patients.
  • Successful treatment of Candida peritonitis hinges on pathogen susceptibility and achieving adequate drug concentrations at the infection site.
Keywords:
ascitesfungal peritonitisintra-abdominal infectionisavuconazoleperitonitis

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