Anidulafungin for prevention of intraabdominal candidiasis in high risk surgical patients
Author(s): Pérez de Lis Novo M., Vidal Seoane M., Rama-Maceiras P., Lopez M., Rey T., Pensado
Castiñeiras A.
Institute(s): Complejo Hospitalario Universitario A Coruña, Department of Anaesthesiology and Perioperative
Medicine, A Coruña, Spain
Text: Background and Goal of Study: Thirty to forty percent of patients with recurrent gastrointestinal
perforation/anastomotic leakage or other severe abdominal process develop intraabdominal
invasive candidiasis (IC). A corrected Candida colonization index (CCI) > 0.4 is a powerful
predictor of IC. Fluconazole prevents intraabdominal IC in this setting, but azole-resistant
Candida species are emerging. The aim of this study was to explore the efficacy and safety of
anidulafungin for prevention of intraabdominal IC in high-risk surgical patient.
Materials and Methods: Retrospective non-comparative single-center study in consecutive adult
surgical patients with abdominal septic shock. Preventive anidulafungin therapy was given until
resolution of the surgical condition. Candida colonization index, occurrence of intra-abdominal IC
and adverse events were monitored.
Results and Discussion: One hundred and fifty patients were studied: 85 (57%) had recurrent
gastrointestinal perforation/anastomotic leakage and 10 (7%) acute necrotizing pancreatitis. The
median duration of preventive anidulafungin therapy was 14 days (range 3-50). Anidulafungin
was successful for prevention of intraabdominal IC in 120/150 patients (80%[1] ). No drug-related
adverse event requiring anidulafungin discontinuation occurred. One hundred and fourteen
patients (76%) survived at 30-days.
Conclusion(s):
- The use of an echinocandin is recommended for hemodynamically unstable patients or with a
history of recent fluconazole exposure.
- Anidulafungin may be efficacious and safe for prevention of intraabdominal candidiasis in highrisk
surgical patients.
- This needs to be further investigated in randomized trials.