Caspofungin (CSP) for prophylaxis of intraabdominal candidiasis (IC) in high- risk surgical patients : A pilot study

Senn, L.S., Eggimann, P., Ksontini, R., Pascual, A., Bille, J., Calandra, T., Marchetti, O.

Author address: 

CHUV, LAUSANNE, Switzerland


Background: We have previously shown that 30-40% of surgical patients with recurrent gastrointestinal perforation/anastomotic leakage, or acute necrotizing pancreatitis develop IC (Lancet 1989, 2:1437). These patients benefit of fluconazole prophylaxis (Crit Care Med 1999, 27:1066). A corrected Candida colonization index (CCI) ≥ 0.4 is a major risk factor for IC (Ann Surg 1994, 220:751). CSP, a new therapy for IC including azole-resistant Candida spp., may be used for prophylaxis of IC. Objective: To conduct a non-comparative pilot study on the efficacy and safety of CSP for prophylaxis of IC in high-risk surgical patients. Methods: Inclusion criteria: age >18, surgery for recurrent gastrointestinal perforations/anastomotic leakage or acute pancreatitis. Exclusion criteria: documented IC, fluconazole prophylaxis. CSP prophylaxis (70 mg, then 50 mg/day) was given until resolution of the surgical condition. Candida colonization was monitored 1x weekly at ≥ 3 sites and the CCI calculated. Success was defined by the absence of IC during CSP prophylaxis. Occurrence of CSP-related SAE was recorded. Results: 19 patients were enrolled: 16/3 males/females, median age 69 (range 40-84). Underlying surgical conditions were: recurrent gastrointestinal perforation/anastomotic leakage (n=16), acute pancreatitis (n=3). At study entry, 14 (74%) patients were in the ICU (median Simplified Acute Physiology Score II: 45, range 31-65), 19 (100%) received antibacterial therapy and 17 (89%) were colonized with Candida (C. albicans in 69%; CCI ≥ 0.4 in 1/17 case, 5%). Median duration of CSP prophylaxis was 16 days (range 4-46). During CSP prophylaxis, 17 (89%) patients remained colonized (C. albicans in 68%), but 0/17 developed a CCI ≥ 0.4. CSP was successful for prevention of IC in 18 (95%) patients. Among 5 deaths, none was attributed to IC. No severe CSP-related SAE requiring discontinuation of prophylaxis occurred. Discussion: The results of this pilot study suggest that caspofungin is efficacious and safe for prophylaxis of intra-abdominal candidiasis in high-risk surgical patients.

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Full conference title: 

3rd Trends in Medical Mycology
    • TIMM 3rd (2011)