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Ottolino P. Managing the Open Abdomen: Selecting an Appropriate Treatment Strategy. Adv Wound Care (New Rochelle) 2024. [PMID: 38963339 DOI: 10.1089/wound.2023.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
Significance: The laparotomy is a common surgical procedure with a wide range of indications. Ideally, once the goals of surgery were achieved, the incision edges could then be approximated and the abdomen primarily closed. However, in some circumstances, it may be impossible to achieve primary closure, and instead the abdomen is intentionally left open. This review discusses the indications and objectives for the open abdomen (OA), summarizes the most common techniques for temporary abdominal closure, and illustrates treatment algorithms grounded in the current recommendations from specialty experts. Recent Advances: Still a relatively young technique, multiple strategies, and technologies have emerged to manage the OA. So too have the recommendations evolved, based on updated classifications that take wound characteristics into account. Recent studies have also brought greater clarity on recommendations for managing infection and malnutrition to support improved clinical outcomes. Critical Issues: The status of the OA can change rapidly depending on the patient's condition, the wound quality, and many other factors. Thus, there is a significant need for comprehensive treatment strategies that can be adapted to these developing circumstances. Future Directions: Treatment recommendations should be continuously updated as new technologies are introduced and old techniques fall out of use.
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Maseda E, Martín-Loeches I, Zaragoza R, Pemán J, Fortún J, Grau S, Aguilar G, Varela M, Borges M, Giménez MJ, Rodríguez A. Critical appraisal beyond clinical guidelines for intraabdominal candidiasis. Crit Care 2023; 27:382. [PMID: 37789338 PMCID: PMC10546659 DOI: 10.1186/s13054-023-04673-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/28/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Regardless of the available antifungals, intraabdominal candidiasis (IAC) mortality continues to be high and represents a challenge for clinicians. MAIN BODY This opinion paper discusses alternative antifungal options for treating IAC. This clinical entity should be addressed separately from candidemia due to the peculiarity of the required penetration of antifungals into the peritoneal cavity. Intraabdominal concentrations may be further restricted in critically ill patients where pathophysiological facts alter normal drug distribution. Echinocandins are recommended as first-line treatment in guidelines for invasive candidiasis. However, considering published data, our pharmacodynamic analysis suggests the required increase of doses, postulated by some authors, to attain adequate pharmacokinetic (PK) levels in peritoneal fluid. Given the limited evidence in the literature on PK/PD-based treatments of IAC, an algorithm is proposed to guide antifungal treatment. Liposomal amphotericin B is advocated as first-line therapy in patients with sepsis/septic shock presenting candidemia or endophthalmitis, or with prior exposure to echinocandins and/or fluconazole, or with infections by Candida glabrata. Other situations and alternatives, such as new compounds or combination therapy, are also analysed. CONCLUSION There is a critical need for more robust clinical trials, studies examining patient heterogeneity and surveillance of antifungal resistance to enhance patient care and optimise treatment outcomes. Such evidence will help refine the existing guidelines and contribute to a more personalised and effective approach to treating this serious medical condition. Meanwhile, it is suggested to broaden the consideration of other options, such as liposomal amphotericin B, as first-line treatment until the results of the fungogram are available and antifungal stewardship could be implemented to prevent the development of resistance.
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Affiliation(s)
- Emilio Maseda
- Service of Anesthesia, Hospital Quirónsalud Valle del Henares, Av. de La Constitución, 249, 28850, Torrejón de Ardoz, Madrid, Spain.
| | - Ignacio Martín-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital, James Street, Leinster, Dublin 8, D08 NHY1, Ireland.
- Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi I Sunyer), University of Barcelona, CIBERes, Barcelona, Spain.
| | | | - Javier Pemán
- Microbiology Department, Hospital Universitari I Politecnic La Fe, Valencia, Spain
- Fundación Micellium, La Eliana, Valencia, Spain
| | - Jesús Fortún
- Infectious Diseases Service, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Santiago Grau
- Service of Pharmacy, Hospital del Mar, Barcelona, Spain
| | - Gerardo Aguilar
- Service of Anesthesia, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Marina Varela
- Service of Anesthesia, Área Sanitaria de Pontevedra, Pontevedra, Spain
| | - Marcio Borges
- ICU, Hospital Universitario Son Llátzer, Palma, Spain
| | - María-José Giménez
- Faculty of Sports Sciences and Physiotherapy, Universidad Europea de Madrid, Madrid, Spain
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Xie M, Shao J, Wan Z, Yan T, Zhu S, Li S, Yu J. Detection of Candida DNA in peritoneal fluids by PCR assay optimizing the diagnosis and treatment for intra-abdominal candidiasis in high-risk ICU patients: A prospective cohort study. Front Microbiol 2023; 13:1070688. [PMID: 36687581 PMCID: PMC9849671 DOI: 10.3389/fmicb.2022.1070688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
Background Intra-abdominal candidiasis (IAC) is the predominant type of invasive candidiasis with high mortality in critically ill patients. This study aimed to investigate whether the polymerase chain reaction (PCR) assay for detecting Candida DNA in peritoneal fluids (PF) is useful in diagnosing and management of IAC in high-risk patients in intensive care unit (ICU). Methods A prospective single-center cohort study of surgical patients at high risk for IAC was conducted in the ICU. PF was collected from the abdominal drainage tubes (within 24 h) or by percutaneous puncture. Direct PF smear microscopy, PF culture, blood culture, and serum (1-3)-β-D-glucan were performed in all patients. For Candida PCR assay, the ITS1/ITS4 primers that targeted the ITS1-5.8 s-ITS2 regions were used for PCR, and sequencing analysis was used to identify the pathogen at the species level. IAC was defined according to the 2013 European consensus criteria. Results Among 83 patients at high risk for IAC, the IAC criteria were present in 17 (20.5%). The sensitivity and specificity of the Candida PCR assay were 64.7 and 89.4%, respectively, and the area under the receiver operating characteristic curve was 0.77 (95% CI: 0.63-0.91). In this cohort, the positive predictive value and negative predictive value were 90.8% (95% CI: 80.3-96.2%) and 61.1% (95% CI: 36.1-81.7%), respectively. Diagnostic consistency was moderate (kappa 0.529, p < 0.001) according to the 2013 European consensus criteria. Conclusion Detection of Candida DNA in PF using PCR can be considered an adjunct to existing routine diagnostic tools which may optimize the diagnosis and antifungal treatment of IAC in high-risk patients in the ICU.
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Affiliation(s)
- Min Xie
- Department of Critical Care Medicine, Peking University First Hospital, Peking University, Beijing, China
| | - Jin Shao
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China,Research Center for Medical Mycology, Peking University, Beijing, China,Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China,National Clinical Research Center for Skin and Immune Diseases, Beijing, China,Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Zhe Wan
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China,Research Center for Medical Mycology, Peking University, Beijing, China,Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China,National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Ting Yan
- Department of Critical Care Medicine, Peking University First Hospital, Peking University, Beijing, China
| | - Sainan Zhu
- Department of Biostatistics, Peking University First Hospital, Peking University, Beijing, China
| | - Shuangling Li
- Department of Critical Care Medicine, Peking University First Hospital, Peking University, Beijing, China,*Correspondence: Shuangling Li, ✉
| | - Jin Yu
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China,Research Center for Medical Mycology, Peking University, Beijing, China,Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China,National Clinical Research Center for Skin and Immune Diseases, Beijing, China,Jin Yu, ✉
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4
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Yoon YK, Moon C, Kim J, Heo ST, Lee MS, Lee S, Kwon KT, Kim SW. Korean Guidelines for Use of Antibiotics for Intra-abdominal Infections in Adults. Infect Chemother 2022; 54:812-853. [PMID: 36596690 PMCID: PMC9840951 DOI: 10.3947/ic.2022.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
The guidelines are intended to provide practical information for the correct use of antibiotics for intra-abdominal infections in Korea. With the aim of realizing evidence-based treatment, these guidelines for the use of antibiotics were written to help clinicians find answers to key clinical questions that arise in the course of patient care, using the latest research results based on systematic literature review. The guidelines were prepared in consideration of the data on the causative pathogens of intra-abdominal infections in Korea, the antibiotic susceptibility of the causative pathogens, and the antibiotics available in Korea.
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Affiliation(s)
- Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.,Korean Society for Antimicrobial Therapy, Seoul, Korea
| | - Chisook Moon
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.,Korean Society of Infectious Diseases, Seoul, Korea
| | - Sang Taek Heo
- Korean Society of Infectious Diseases, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Mi Suk Lee
- Korean Society of Infectious Diseases, Seoul, Korea.,Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Shinwon Lee
- Korean Society of Infectious Diseases, Seoul, Korea.,Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ki-Tae Kwon
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Shin-Woo Kim
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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5
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Bassetti M, Vena A, Giacobbe DR, Trucchi C, Ansaldi F, Antonelli M, Adamkova V, Alicino C, Almyroudi MP, Atchade E, Azzini AM, Brugnaro P, Carannante N, Peghin M, Berruti M, Carnelutti A, Castaldo N, Corcione S, Cortegiani A, Dimopoulos G, Dubler S, García-Garmendia JL, Girardis M, Cornely OA, Ianniruberto S, Kullberg BJ, Lagrou K, Lebihan C, Luzzati R, Malbrain M, Merelli M, Marques AJ, Martin-Loeches I, Mesini A, Paiva JA, Raineri SM, Rautemaa-Richardson R, Schouten J, Spapen H, Tasioudis P, Timsit JF, Tisa V, Tumbarello M, Van den Berg CHSB, Veber B, Venditti M, Voiriot G, Wauters J, Zappella N, Montravers P. Risk Factors for Intra-Abdominal Candidiasis in Intensive Care Units: Results from EUCANDICU Study. Infect Dis Ther 2022; 11:827-840. [PMID: 35182353 PMCID: PMC8960530 DOI: 10.1007/s40121-021-00585-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/14/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Intra-abdominal infections represent the second most frequently acquired infection in the intensive care unit (ICU), with mortality rates ranging from 20% to 50%. Candida spp. may be responsible for up to 10-30% of cases. This study assesses risk factors for development of intra-abdominal candidiasis (IAC) among patients admitted to ICU. METHODS We performed a case-control study in 26 European ICUs during the period January 2015-December 2016. Patients at least 18 years old who developed an episode of microbiologically documented IAC during their stay in the ICU (at least 48 h after admission) served as the case cohort. The control group consisted of adult patients who did not develop episodes of IAC during ICU admission. Matching was performed at a ratio of 1:1 according to time at risk (i.e. controls had to have at least the same length of ICU stay as their matched cases prior to IAC onset), ICU ward and period of study. RESULTS During the study period, 101 case patients with a diagnosis of IAC were included in the study. On univariate analysis, severe hepatic failure, prior receipt of antibiotics, prior receipt of parenteral nutrition, abdominal drain, prior bacterial infection, anastomotic leakage, recurrent gastrointestinal perforation, prior receipt of antifungal drugs and higher median number of abdominal surgical interventions were associated with IAC development. On multivariate analysis, recurrent gastrointestinal perforation (OR 13.90; 95% CI 2.65-72.82, p = 0.002), anastomotic leakage (OR 6.61; 95% CI 1.98-21.99, p = 0.002), abdominal drain (OR 6.58; 95% CI 1.73-25.06, p = 0.006), prior receipt of antifungal drugs (OR 4.26; 95% CI 1.04-17.46, p = 0.04) or antibiotics (OR 3.78; 95% CI 1.32-10.52, p = 0.01) were independently associated with IAC. CONCLUSIONS Gastrointestinal perforation, anastomotic leakage, abdominal drain and prior receipt of antifungals or antibiotics may help to identify critically ill patients with higher probability of developing IAC. Prospective studies are needed to identify which patients will benefit from early antifungal treatment.
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Affiliation(s)
- Matteo Bassetti
- Clinica Malattie Infettive. Ospedale Policlinico San Martino - IRCCS, L.go R. Benzi 10, 16132, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Antonio Vena
- Clinica Malattie Infettive. Ospedale Policlinico San Martino - IRCCS, L.go R. Benzi 10, 16132, Genoa, Italy.
- Department of Health Sciences, University of Genoa, Genoa, Italy.
| | - Daniele R Giacobbe
- Clinica Malattie Infettive. Ospedale Policlinico San Martino - IRCCS, L.go R. Benzi 10, 16132, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Cecilia Trucchi
- A.Li.Sa. Liguria Health Authority, Genoa, Italy
- Healthcare Planning Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Filippo Ansaldi
- A.Li.Sa. Liguria Health Authority, Genoa, Italy
- Healthcare Planning Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Massimo Antonelli
- Department of Intensive Care Anesthesiology and Emercency Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Vaclava Adamkova
- Clinical Microbiology and ATB Centre, Institute of Medical Biochemistry and Laboratory Diagnostics, General University Hospital, Prague, Czech Republic
- Department of Medical Microbiology, Medical Faculty of Palackeho University, Olomouc, Czech Republic
| | - Cristiano Alicino
- Medical Direction, Santa Corona Hospital, ASL 2 Regional Health System of Liguria, Pietra Ligure, Italy
| | | | - Enora Atchade
- Département d'Anesthésie-Réanimation, CHU Bichat-Claude Bernard, HUPNVS, APHP, Paris, France
| | - Anna M Azzini
- Department of Diagnostics and Public Health, Infectious Disease Unit, University of Verona, Verona, Italy
| | | | - Novella Carannante
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy
| | - Maddalena Peghin
- Infectious Diseases Clinic, Santa Maria della Misericordia University Hospital of Udine, ASUFC, Udine, Italy
| | - Marco Berruti
- Clinica Malattie Infettive. Ospedale Policlinico San Martino - IRCCS, L.go R. Benzi 10, 16132, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Alessia Carnelutti
- Infectious Diseases Clinic, Santa Maria della Misericordia University Hospital of Udine, ASUFC, Udine, Italy
| | - Nadia Castaldo
- Infectious Diseases Clinic, Santa Maria della Misericordia University Hospital of Udine, ASUFC, Udine, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - George Dimopoulos
- Department of Critical Care, University Hospital Attikon, Attikon Medical School, Νational and Kapodistrian University of Athens, Athens, Greece
| | - Simon Dubler
- Department of Anesthesiology and Intensive Care Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - José L García-Garmendia
- Servicio de Cuidados Críticos y Urgencias, Hospital San Juan de Dios del Aljarafe, Bormujos, Seville, Spain
| | - Massimo Girardis
- Department of Anesthesia and Intensive Care, University Hospital of Modena, Modena, Italy
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Stefano Ianniruberto
- Infectious Diseases Unit, Department of Medical and Surgical Science, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Bart Jan Kullberg
- Radboud Umc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katrien Lagrou
- Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals of Leuven, Leuven, Belgium
- Department of Microbiology and Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Clement Lebihan
- APHP; Medical and Infectious Diseases ICU (MI2), Bichat Hospital, 75018, Paris, France
| | - Roberto Luzzati
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata Di Trieste, Trieste, Italy
| | - Manu Malbrain
- Department of Intensive Care Medicine, University Hospital Brussels (UZB), 1090, Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Unversiteit Brussel (VUB), 1090, Brussels, Belgium
| | - Maria Merelli
- Infectious Diseases Clinic, Santa Maria della Misericordia University Hospital of Udine, ASUFC, Udine, Italy
| | - Ana J Marques
- C.H. Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer - University of Barcelona, Barcelona, Spain
| | - Alessio Mesini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - José-Artur Paiva
- Department of Emergency and Intensive Care Medicine, Centro Hospitalar Universitário São João, Faculdade de Medicina da Universidade Do Porto E Grupo de Infecção E Sépsis, Porto, Portugal
| | - Santi Maurizio Raineri
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Institute for Biomedical Research and Innovation (IRIB) - National Research Council (CNR), Palermo, Italy
| | - Riina Rautemaa-Richardson
- Faculty of Biology, Medicine and Health, Division of Evolution, Infection and Genomics, University of Manchester, Manchester, UK
- Department of Infectious Diseases, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Jeroen Schouten
- Radboud Umc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Herbert Spapen
- Universitair Ziekenhuis Brussel, VUB University, Brussels, Belgium
| | | | - Jean-François Timsit
- Université Paris Diderot/Hopital Bichat-Réanimation Medicale et Des Maladies Infectieuses, Paris, France
- UMR 1137-IAME Team 5-DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Inserm/Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Valentino Tisa
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Mario Tumbarello
- Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Benoit Veber
- Pole Anesthésie-Réanimation-SAMU, Rouen University Hospital, Rouen, France
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Guillaume Voiriot
- Service de Réanimation Et USC Médico-Chirurgicale, AP-HP, Hôpitaux Universitaires de L'Est Parisien, Pôle TVAR, Hôpital Tenon, Paris, France
| | - Joost Wauters
- Department of General Internal Medicine, Medical Intensive Care Unit, University Hospitals Leuven, Leuven, UK
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Zaragoza R, Maseda E, Pemán J. [Individualized antifungal therapy in critically ill patients with invasive fungal infection]. Rev Iberoam Micol 2021; 38:68-74. [PMID: 34301466 DOI: 10.1016/j.riam.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/16/2021] [Accepted: 04/28/2021] [Indexed: 12/12/2022] Open
Abstract
Invasive candidiasis (IC) is the most common invasive fungal infection (IFI) affecting critically ill patients, followed by invasive pulmonary aspergillosis (IPA). International guidelines provide different recommendations for a first-line antifungal therapy and, in most of them, echinocandins are considered the first-line treatment for IC, and triazoles are so for the treatment of IPA. However, liposomal amphotericinB (L-AmB) is still considered a second-line therapy for both clinical entities. Although in the last decade the management of IFI has improved, several controversies persist. The antifungal drugs currently available may have a suboptimal activity, or be wrongly used in certain IFI involving critically ill patients. The aim of this review is to analyze when to provide individualized antifungal therapy to critically ill patients suffering from IFI, emphasizing the role of L-AmB. Drug-drug interactions, the clinical status, infectious foci (peritoneal candidiasis is discussed), the fungal species involved, and the need of monitoring the concentration of the antifungal drug in the patient are considered.
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Affiliation(s)
- Rafael Zaragoza
- Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, España.
| | - Emilio Maseda
- Unidad de Críticos Quirúrgicos, Servicio de Anestesia y Reanimación, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Javier Pemán
- Servicio de Microbiología, Hospital Universitario y Politécnico la Fe, Valencia, España
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7
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Andrade JT, Lima WG, Sousa JF, Saldanha AA, Nívea Pereira De Sá, Morais FB, Prates Silva MK, Ribeiro Viana GH, Johann S, Soares AC, Araújo LA, Antunes Fernandes SO, Cardoso VN, Siqueira Ferreira JM. Design, synthesis, and biodistribution studies of new analogues of marine alkaloids: Potent in vitro and in vivo fungicidal agents against Candida spp. Eur J Med Chem 2021; 210:113048. [PMID: 33316690 DOI: 10.1016/j.ejmech.2020.113048] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/26/2020] [Accepted: 11/23/2020] [Indexed: 12/28/2022]
Abstract
Invasive candidiasis, such as intra-abdominal candidiasis (IAC), is a significant cause of morbidity and mortality worldwide. IAC is still poorly understood, and its treatment represents a challenge for public health. In this study, we showed the in vitro anti-Candida activity of four alkaloid synthetic derivatives and their antifungal potential in a murine model of IAC. The biological effects of alkaloids were evaluated against Candida spp. through the determination of the minimum inhibitory concentration (MIC). For the alkaloids that showed antifungal activity, the fungicidal concentration, time-kill curve, synergism with azoles and polyenes, phenotypic effects, and the effect against virulence factors were also determined. The most active alkaloids were selected for in vivo assays. The compounds 6a and 6b were active against C. albicans, C. glabrata, and C. tropicalis (MIC 7.8 μg/mL) and showed promising antifungal activity against C. krusei (MIC 3.9 μg/mL). The compound 6a presented a potent fungicidal effect in vitro, eliminating the yeast C. albicans after 8 h of incubation at MIC. An important in vitro synergistic effect with ketoconazole was observed for these two alkaloids. They also induced the lysis of fungal cells by binding to the ergosterol of the membrane. Besides that, 6a and 6b were able to reduce yeast-to-hyphal transition in C. albicans, as well as inhibit the biofilm formation of this pathogen. In the in vivo assay, the compound 6a did not show acute toxicity and was mainly absorbed by the liver, spleen, and lung after a parenteral administration. Also, this analogue significantly reduced the fungal load of C. albicans on the kidney and spleen of animals with IAC. Therefore, these results showed that the compound 6a is a potent anti-Candida agent in vitro and in vivo.
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Affiliation(s)
- Jéssica Tauany Andrade
- Laboratório de Microbiologia Médica, Campus Universidade Federal de São João Del-Rei (UFSJ), Centro-Oeste Dona Lindu, Divinópolis, Minas Gerais, Brazil
| | - William Gustavo Lima
- Laboratório de Microbiologia Médica, Campus Universidade Federal de São João Del-Rei (UFSJ), Centro-Oeste Dona Lindu, Divinópolis, Minas Gerais, Brazil; Laboratório de Radioisótopos, Departamento de Análises Clinicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Jaqueline França Sousa
- Laboratório de Compostos Bioativos e Catalíticos, Campus Universidade Federal de São João Del-Rei (UFSJ), Centro-Oeste Dona Lindu, Divinópolis, Minas Gerais, Brazil
| | - Aline Aparecida Saldanha
- Laboratório de Farmacologia da Dor e Inflamação, Campus Universidade Federal de São João Del-Rei (UFSJ), Centro-Oeste Dona Lindu, Divinópolis, Minas Gerais, Brazil
| | - Nívea Pereira De Sá
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Fernanda Barbara Morais
- Laboratório de Microbiologia Médica, Campus Universidade Federal de São João Del-Rei (UFSJ), Centro-Oeste Dona Lindu, Divinópolis, Minas Gerais, Brazil
| | - Mayra Karla Prates Silva
- Laboratório de Microbiologia Médica, Campus Universidade Federal de São João Del-Rei (UFSJ), Centro-Oeste Dona Lindu, Divinópolis, Minas Gerais, Brazil
| | - Gustavo Henrique Ribeiro Viana
- Laboratório de Compostos Bioativos e Catalíticos, Campus Universidade Federal de São João Del-Rei (UFSJ), Centro-Oeste Dona Lindu, Divinópolis, Minas Gerais, Brazil
| | - Susana Johann
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Adriana Cristina Soares
- Laboratório de Farmacologia da Dor e Inflamação, Campus Universidade Federal de São João Del-Rei (UFSJ), Centro-Oeste Dona Lindu, Divinópolis, Minas Gerais, Brazil
| | - Leonardo Allan Araújo
- Serviço de Recursos Vegetais e Opoterápicos (SRVO), Diretoria de Pesquisa (DPD), Fundação Ezequiel Dias (FUNED), Belo Horizonte, MG, Brazil
| | - Simone Odília Antunes Fernandes
- Laboratório de Radioisótopos, Departamento de Análises Clinicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Valbert Nascimento Cardoso
- Laboratório de Radioisótopos, Departamento de Análises Clinicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Jaqueline Maria Siqueira Ferreira
- Laboratório de Microbiologia Médica, Campus Universidade Federal de São João Del-Rei (UFSJ), Centro-Oeste Dona Lindu, Divinópolis, Minas Gerais, Brazil.
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Wang Y, Guo J, Xiong T, Wang F, Kou G, Ning H. The quality assessment of intraabdominal infection guidelines/consensuses in 2 decades - which are better and any changes? Medicine (Baltimore) 2020; 99:e23643. [PMID: 33327344 PMCID: PMC7738084 DOI: 10.1097/md.0000000000023643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/12/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND AIM Intraabdominal infection (IAI) is a common and important disease worldwide. An increasing number of related guidelines/consensuses have been published in recent years, the quality evaluation for these guidelines/consensuses is necessary to identify lower-quality documents and explore the quality distribution in different time range and areas in this field. METHODS The Appraisal of Guidelines for Research & Evaluation Instrument tool was adopted to assess the quality of IAI guidelines/consensuses by 3 researchers independently. Intraclass correlation coefficients (ICCs) among the researchers were retrieved to reflect reliability. The quality differences of these guidelines/consensuses issued before and after May 2009, both international and non-international, were compared by a Mann-Whitney U test. RESULTS Fourteen IAI guidelines/consensuses published in English were obtained following a literature search. The ICCs among the researchers were all above 0.75, indicating satisfactory reliability. This outcome showed that the overall quality of these guidelines/consensuses was mediocre and considered acceptable in all items. A few guidelines/consensuses were better in their scientific and methodological characteristics than the others. Moreover, there were no significant differences in the scores between the guidelines/consensuses issued before and after May 2009 or between international vs regional guidelines/consensuses. CONCLUSIONS Overall, the quality of the IAI guidelines/consensuses was generally acceptable and applicable, with a few deficiencies. Therefore, continuous improvement is essential. The guideline assessment tools should be applied in guideline/consensus development both widely and strictly to improve the methodological quality.
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Affiliation(s)
- Yu Wang
- Department of Pharmacy
- Northwestern SiChuan Regional Medical Center, MianYang, China
| | - Jun Guo
- Department of Pediatrics, MianYang Center Hospital, MianYang
- Northwestern SiChuan Regional Medical Center, MianYang, China
| | - Tingting Xiong
- Department of Pharmacy, sichuan provincial hospital for women and children, Chengdu
| | - Fangfang Wang
- Department of Pharmacy, Yibin hospital for women and children, Yibin
| | - Guoxian Kou
- Department of Infectious Diseases
- Northwestern SiChuan Regional Medical Center, MianYang, China
| | - Hong Ning
- Department of Pharmacy, MianYang Center Hospital
- Northwestern SiChuan Regional Medical Center, MianYang, China
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Experience of a fungal infection after cardiac surgery. ACTA ACUST UNITED AC 2019; 66:307-314. [PMID: 30871794 DOI: 10.1016/j.redar.2019.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Patients undergoing cardiac surgery can have post-operative complications, including infections. The aim of this article was to study the incidence, severity and risk factors of invasive candidiasis in these patients, based on the hypothesis that several factors (multiple transfusions and time on extracorporeal circulation) are related to invasive candidiasis. MATERIAL AND METHODS The study included a prospective analysis of 669 patients undergoing scheduled cardiac surgery from April 2016 to December 2017. Control cultures were collected on admittance to the Surgical Intensive Care Unit. RESULTS The incidence of invasive candidiasis was 2.69%, being confirmed in 1.79% of cases. The most frequently isolated Candida species was Candida auris. Mortality rate in the invasive candidiasis group was 11% in the immediate post-operative period and 22% at 30 days. After the univariate study, a statistically significant relationship was found between invasive candidiasis and multiple transfusions (OR 15.86; 95% CI: 5.15-69.4; p<.001). A statistically significant relationship was also found with other known risk factors in hospitalised patients. CONCLUSIONS Multiple transfusions are associated with an increased risk of invasive candidiasis. Surveillance measures for fungal infection in patients with risk factors undergoing cardiac surgery should be implemented in hospitals with a high incidence of candidiasis.
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Lima WG, Alves-Nascimento LA, Andrade JT, Vieira L, de Azambuja Ribeiro RIM, Thomé RG, dos Santos HB, Ferreira JMS, Soares AC. Are the Statins promising antifungal agents against invasive candidiasis? Biomed Pharmacother 2019; 111:270-281. [DOI: 10.1016/j.biopha.2018.12.076] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/22/2018] [Accepted: 12/17/2018] [Indexed: 12/16/2022] Open
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Comparison of Killing Activity of Micafungin Against Six Candida Species Isolated from Peritoneal and Pleural Cavities in RPMI-1640, 10 and 30% Serum. Mycopathologia 2018; 183:905-912. [PMID: 30382508 DOI: 10.1007/s11046-018-0302-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/11/2018] [Indexed: 12/20/2022]
Abstract
Currently echinocandins are recommended in Candida peritonitis and pleuritis. We determined micafungin killing rates (k values) at therapeutic concentrations (0.25-2 mg/L) in RPMI-1640 with and without 10 and 30% serum mimicking in vivo conditions against six Candida species isolated from peritoneal and pleural fluid. In RPMI-1640, micafungin was fungicidal against C. glabrata, C. krusei and C. kefyr within 2.27 ± 10.68, 2.69 ± 10.29 and 3.10 ± 4.41 h, respectively, while was fungistatic against C. albicans, C. tropicalis and C. parapsilosis. In 10% serum, ≥ 0.25, ≥ 0.5, ≥ 0.5 and ≥ 1 mg/L micafungin produced positive k values (killing) for all C. albicans, C. glabrata, C. kefyr and C. krusei, respectively. In 30% serum, 2 mg/L micafungin produced killing against all C. albicans, C. glabrata and C. kefyr isolates, but was ineffective against C. krusei, C. parapsilosis and 2 of 3 C. tropicalis. Micafungin exposure should be increased against non-albicans species to eradicate fungi from peritoneal and pleural cavities.
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Calabuig E, Camarena JJ, Carbonell N. Update on the management of intra-abdominal Candida infections. Rev Iberoam Micol 2017; 34:127-129. [DOI: 10.1016/j.riam.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/19/2017] [Accepted: 02/17/2017] [Indexed: 12/24/2022] Open
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