A research agenda on the management of intra-abdominal candidiasis: results from a consensus of multinational experts
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- 作者：Matteo Bassetti (1) (21)
Monia Marchetti (2)
Arunaloke Chakrabarti (3)
Sergio Colizza (4)
Jose Garnacho-Montero (5)
Daniel H. Kett (6)
Patricia Munoz (7)
Francesco Cristini (8)
Anastasia Andoniadou (9)
Pierluigi Viale (8)
Giorgio Della Rocca (10)
Emmanuel Roilides (9)
Gabriele Sganga (11)
Thomas J. Walsh (12)
Carlo Tascini (13)
Mario Tumbarello (14)
Francesco Menichetti (13)
Elda Righi (1)
Christian Eckmann (15)
Claudio Viscoli (16)
Andrew F. Shorr (17)
Olivier Leroy (18)
George Petrikos (19)
Francesco Giuseppe De Rosa (20) - 关键词：Candida ; Abdominal infections ; Consensus
- 刊名：Intensive Care Medicine
- 出版年：2013
- 出版时间：December 2013
- 年：2013
- 卷：39
- 期：12
- 页码：2092-2106
- 全文大小：
- 作者单位：Matteo Bassetti (1) (21)
Monia Marchetti (2)
Arunaloke Chakrabarti (3)
Sergio Colizza (4)
Jose Garnacho-Montero (5)
Daniel H. Kett (6)
Patricia Munoz (7)
Francesco Cristini (8)
Anastasia Andoniadou (9)
Pierluigi Viale (8)
Giorgio Della Rocca (10)
Emmanuel Roilides (9)
Gabriele Sganga (11)
Thomas J. Walsh (12)
Carlo Tascini (13)
Mario Tumbarello (14)
Francesco Menichetti (13)
Elda Righi (1)
Christian Eckmann (15)
Claudio Viscoli (16)
Andrew F. Shorr (17)
Olivier Leroy (18)
George Petrikos (19)
Francesco Giuseppe De Rosa (20)
1. Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
21. Infectious Disease Division, Azienda Ospedaliera Universitaria Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy
2. Hematology Unit, Oncology Department, Hospital C. Massaia, Asti, Italy
3. Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
4. Department of General Surgery, Fatebenefratelli-Isola Tiberina, Rome, Italy
5. Critical Care and Emergency Clinical Unit, Hospital Universitario Virgen del Roc, Sevilla, Spain
6. The Miller School of Medicine at the University of Miami, Jackson Memorial Hospital, Miami, USA
7. Servicio de Microbiolog-Enfermedades Infecciosas, Hospital General Universitario Gregorio Mara, Madrid, Spain
8. Clinica Malattie Infettive, Dipartimento Scienze Mediche e Chirurgiche, Universitdi Bologna, Bologna, Italy
9. Third Department Pediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
10. Clinica di Anestesia e Rianimazione, University of Udine, Udine, Italy
11. Division of General Surgery and Organ Transplantation, Department of Surgery, Catholic University of Rome, Rome, Italy
12. Medical Mycology Research Laboratory, Weill Cornell Medical Center and Cornell University, New York, USA
13. U.O.C. Malattie Infettive, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
14. Institute of Infectious Diseases, UniversitCattolica del Sacro Cuore, Rome, Italy
15. Department of General, Visceral and Thoracic Surgery, Klinikum Peine Academic Hospital of Medical University Hannover, Hannover, Germany
16. Infectious Disease Clinic, San Martino Hospital, University of Genoa, Genoa, Italy
17. Pulmonary and Critical Care Medicine Division, Washington Hospital Center, Washington, DC, USA
18. Service de Rnimation et Maladies Infectieuses, Centre Hospitalier Chatiliez, Tourcoing, France
19. Fourth Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
20. Department of Medical Sciences, Infectious Diseases Clinic at Amedeo di Savoia Hospital, University of Turin, Turin, Italy - ISSN：1432-1238
文摘
Introduction intra-abdominal candidiasis (IAC) may include Candida involvement of peritoneum or intra-abdominal abscess and is burdened by high morbidity and mortality rates in surgical patients. Unfortunately, international guidelines do not specifically address this particular clinical setting due to heterogeneity of definitions and scant direct evidence. In order to cover this unmet clinical need, the Italian Society of Intensive Care and the International Society of Chemotherapy endorsed a project aimed at producing practice recommendations for the management of immune-competent adult patients with IAC. Methods A multidisciplinary expert panel of 22 members (surgeons, infectious disease and intensive care physicians) was convened and assisted by a methodologist between April 2012 and May 2013. Evidence supporting each statement was graded according to the European Society of Clinical Microbiology and Infection Diseases (ESCMID) grading system. Results Only a few of the numerous recommendations can be summarized in the Abstract. Direct microscopy examination for yeast detection from purulent and necrotic intra-abdominal specimens during surgery or by percutaneous aspiration is recommended in all patients with nonappendicular abdominal infections including secondary and tertiary peritonitis. Samples obtained from drainage tubes are not valuable except for evaluation of colonization. Prophylactic usage of fluconazole should be adopted in patients with recent abdominal surgery and recurrent gastrointestinal perforation or anastomotic leakage. Empirical antifungal treatment with echinocandins or lipid formulations of amphotericinB should be strongly considered in critically ill patients or those with previous exposure to azoles and suspected intra-abdominal infection with at least one specific risk factor for Candida infection. In patients with nonspecific risk factors, a positive mannan/antimannan or (1)-d-glucan (BDG) or polymerase chain reaction (PCR) test result should be present to start empirical therapy. Fluconazole can be adopted for the empirical and targeted therapy of non-critically ill patients without previous exposure to azoles unless they are known to be colonized with a Candida strain with reduced susceptibility to azoles. Treatment can be simplified by stepping down to an azole (fluconazole or voriconazole) after at least 5days of treatment with echinocandins or lipid formulations of amphotericinB, if the species is susceptible and the patient has clinically improved. Conclusions Specific recommendations were elaborated on IAC management based on the best direct and indirect evidence and on the expertise of a multinational panel.