Are there Patients with Peritonitis who Require Empiric Therapy for Candida?

THIERRY CALANDRA, MD, PHD

Author address: 

CHUV, Lausanne, Switzerland.

Abstract: 

Invasive mycoses have emerged as a major cause of morbidity and mortality in critically ill surgical patients.Epidemiological studies have shown that surgery services have the highest rate of Candida infections among major specialty departments. In addition to classical risk factors, heavy colonization with Candida, recurrent gastrointestinal perforations and acute pancreatitis are conditions frequently associated with invasive candidiasis in surgical patients. Prompt initiation of antifungal therapy is critical to cure invasive mycoses, but is difficult to accomplish in practice. Prevention of fungal infections may therefore help to reduce the high morbidity and mortality associated with the occurrence of such infections in surgical patients. Yet, few prophylactic or pre-emptive studies have been performed in surgical patients to date. In post-abdominal surgery patients, we found that fluconazole prophylaxis prevented intra-abdominal candidiasis in high-risk surgical patients with recurrent gastro-intestinal perforations or anastomotic leaks. New antifungal agents with remarkable efficacy and safety profiles have recently been added to our therapeutic armementarium against invasive mycoses and will soon offer new treatment options for the management of critically ill surgical patients with lingering intraabdominal conditions. Rigorous selection of high risk patients will be crucial to optimize the risk/benefit ratio of preventive antifungal treatment strategies with the aim to maximize the chances of reducing the morbidity and mortality, while minimizing treatment costs and the exposure of low risk patients to adverse events and emergence of resistant fungal strains
2003

abstract No: 

2080

Full conference title: 

43rd Interscience Conference on Antimicrobial Agents
    • ICAAC 43rd