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Published on: November 6, 2020
Review on the management of intra-abdominal candidiasis
Pedro Puerta-Alcalde1,2,3, Jesús Guinea4,5,6,7, Emilio Maseda8,9
1Hospital Germans Trias i Pujol, Badalona, Spain.
Abstract:
Intra-abdominal candidiasis, which includes Candida peritonitis and Candida produced intra-abdominal abscesses, accounts for 10-30% of all intra-abdominal infections diagnosed in the intensive care units. Intra-abdominal candidiasis is associated with longer hospital stay, and significantly higher morbidity and mortality. Although the management of invasive candidiasis has greatly improved in these past years, the optimal management of intra-abdominal candidiasis remains elusive. Questions concerning the microbiological diagnosis, optimal antifungal drugs doses, diffusion through peritoneal fluid, and the value of liposomal amphotericin B as first-line treatment, remain unanswered. In this article, three important issues concerning intraabdominal candidiasis have been re-viewed: microbiological diagnosis and risk of antifungal resistance emergence, pharmacokinetic/pharmacodynamic particularities of antifungals, and clinical management on the daily practice. Only an optimized multidisciplinary approach combining rapid diagnostics, tailored antifungal therapy, and effective source control will improve the management and prognosis of patients with intra-abdominal candidiasis.
Insights
Intra-abdominal candidiasis significantly increases ICU patient mortality and hospital stay. An optimized multidisciplinary approach is crucial for improving outcomes in these complex infections.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Clinical Microbiology
Background:
- Intra-abdominal candidiasis, including Candida peritonitis and abscesses, constitutes 10-30% of ICU-diagnosed intra-abdominal infections.
- Associated with prolonged hospitalization, increased morbidity, and higher mortality rates.
- Optimal management strategies for intra-abdominal candidiasis remain inadequately defined despite advances in invasive candidiasis treatment.
Purpose of the Study:
- To review key challenges in managing intra-abdominal candidiasis.
- To address microbiological diagnosis, antifungal dosing, peritoneal fluid penetration, and the role of liposomal amphotericin B.
- To provide insights into antifungal resistance, pharmacokinetics/pharmacodynamics, and daily clinical practice.
Main Methods:
- Literature review focusing on microbiological diagnosis, antifungal pharmacokinetics/pharmacodynamics, and clinical management.
- Analysis of current data regarding antifungal resistance emergence.
- Evaluation of treatment strategies in intensive care unit settings.
Main Results:
- Microbiological diagnosis and the risk of antifungal resistance are critical considerations.
- Pharmacokinetic and pharmacodynamic properties of antifungals influence treatment efficacy.
- Clinical management requires careful consideration of drug choice, dosing, and source control.
Conclusions:
- An optimized multidisciplinary approach is essential for improving patient outcomes.
- Rapid diagnostics, tailored antifungal therapy, and effective source control are paramount.
- Addressing diagnostic and therapeutic uncertainties can enhance the prognosis of intra-abdominal candidiasis.
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