A research agenda on the management of intra-abdominal candidiasis: Results from a consensus of multinational experts

Matteo Bassetti, Monia Marchetti, Arunaloke Chakrabarti, Sergio Colizza, Jose Garnacho-Montero, Daniel H. Kett, Patricia Munoz, Francesco Cristini, Anastasia Andoniadou, Pierluigi Viale, Giorgio Della Rocca, Emmanuel Roilides, Gabriele Sganga, Thomas J. Walsh, Carlo Tascini, Mario Tumbarello, Francesco Menichetti, Elda Righi, Christian Eckmann, Claudio ViscoliAndrew F. Shorr, Olivier Leroy, George Petrikos, Francesco Giuseppe De Rosa

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

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 amphotericin B 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→3)-β-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 5-7 days of treatment with echinocandins or lipid formulations of amphotericin B, 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.

Original languageEnglish
Pages (from-to)2092-2106
Number of pages15
JournalIntensive Care Medicine
Volume39
Issue number12
DOIs
Publication statusPublished - Dec 2013

Fingerprint

Candidiasis
Azoles
Research
Fluconazole
Candida
Echinocandins
Amphotericin B
Critical Care
Infection
Intraabdominal Infections
Abdominal Abscess
Lipids
Therapeutics
Mannans
Anastomotic Leak
Glucans
Peritoneum
Practice Management
Microbiology
Peritonitis

Keywords

  • Abdominal infections
  • Candida
  • Consensus

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Bassetti, M., Marchetti, M., Chakrabarti, A., Colizza, S., Garnacho-Montero, J., Kett, D. H., ... De Rosa, F. G. (2013). A research agenda on the management of intra-abdominal candidiasis: Results from a consensus of multinational experts. Intensive Care Medicine, 39(12), 2092-2106. https://doi.org/10.1007/s00134-013-3109-3

A research agenda on the management of intra-abdominal candidiasis : Results from a consensus of multinational experts. / Bassetti, Matteo; Marchetti, Monia; Chakrabarti, Arunaloke; Colizza, Sergio; Garnacho-Montero, Jose; Kett, Daniel H.; Munoz, Patricia; Cristini, Francesco; Andoniadou, Anastasia; Viale, Pierluigi; Rocca, Giorgio Della; Roilides, Emmanuel; Sganga, Gabriele; Walsh, Thomas J.; Tascini, Carlo; Tumbarello, Mario; Menichetti, Francesco; Righi, Elda; Eckmann, Christian; Viscoli, Claudio; Shorr, Andrew F.; Leroy, Olivier; Petrikos, George; De Rosa, Francesco Giuseppe.

In: Intensive Care Medicine, Vol. 39, No. 12, 12.2013, p. 2092-2106.

Research output: Contribution to journalArticle

Bassetti, M, Marchetti, M, Chakrabarti, A, Colizza, S, Garnacho-Montero, J, Kett, DH, Munoz, P, Cristini, F, Andoniadou, A, Viale, P, Rocca, GD, Roilides, E, Sganga, G, Walsh, TJ, Tascini, C, Tumbarello, M, Menichetti, F, Righi, E, Eckmann, C, Viscoli, C, Shorr, AF, Leroy, O, Petrikos, G & De Rosa, FG 2013, 'A research agenda on the management of intra-abdominal candidiasis: Results from a consensus of multinational experts', Intensive Care Medicine, vol. 39, no. 12, pp. 2092-2106. https://doi.org/10.1007/s00134-013-3109-3
Bassetti, Matteo ; Marchetti, Monia ; Chakrabarti, Arunaloke ; Colizza, Sergio ; Garnacho-Montero, Jose ; Kett, Daniel H. ; Munoz, Patricia ; Cristini, Francesco ; Andoniadou, Anastasia ; Viale, Pierluigi ; Rocca, Giorgio Della ; Roilides, Emmanuel ; Sganga, Gabriele ; Walsh, Thomas J. ; Tascini, Carlo ; Tumbarello, Mario ; Menichetti, Francesco ; Righi, Elda ; Eckmann, Christian ; Viscoli, Claudio ; Shorr, Andrew F. ; Leroy, Olivier ; Petrikos, George ; De Rosa, Francesco Giuseppe. / A research agenda on the management of intra-abdominal candidiasis : Results from a consensus of multinational experts. In: Intensive Care Medicine. 2013 ; Vol. 39, No. 12. pp. 2092-2106.
@article{850deb34eec6424b99fc9daf7af8542a,
title = "A research agenda on the management of intra-abdominal candidiasis: Results from a consensus of multinational experts",
abstract = "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 amphotericin B 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→3)-β-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 5-7 days of treatment with echinocandins or lipid formulations of amphotericin B, 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.",
keywords = "Abdominal infections, Candida, Consensus",
author = "Matteo Bassetti and Monia Marchetti and Arunaloke Chakrabarti and Sergio Colizza and Jose Garnacho-Montero and Kett, {Daniel H.} and Patricia Munoz and Francesco Cristini and Anastasia Andoniadou and Pierluigi Viale and Rocca, {Giorgio Della} and Emmanuel Roilides and Gabriele Sganga and Walsh, {Thomas J.} and Carlo Tascini and Mario Tumbarello and Francesco Menichetti and Elda Righi and Christian Eckmann and Claudio Viscoli and Shorr, {Andrew F.} and Olivier Leroy and George Petrikos and {De Rosa}, {Francesco Giuseppe}",
year = "2013",
month = "12",
doi = "10.1007/s00134-013-3109-3",
language = "English",
volume = "39",
pages = "2092--2106",
journal = "Intensive Care Medicine",
issn = "0342-4642",
publisher = "Springer Verlag",
number = "12",

}

TY - JOUR

T1 - A research agenda on the management of intra-abdominal candidiasis

T2 - Results from a consensus of multinational experts

AU - Bassetti, Matteo

AU - Marchetti, Monia

AU - Chakrabarti, Arunaloke

AU - Colizza, Sergio

AU - Garnacho-Montero, Jose

AU - Kett, Daniel H.

AU - Munoz, Patricia

AU - Cristini, Francesco

AU - Andoniadou, Anastasia

AU - Viale, Pierluigi

AU - Rocca, Giorgio Della

AU - Roilides, Emmanuel

AU - Sganga, Gabriele

AU - Walsh, Thomas J.

AU - Tascini, Carlo

AU - Tumbarello, Mario

AU - Menichetti, Francesco

AU - Righi, Elda

AU - Eckmann, Christian

AU - Viscoli, Claudio

AU - Shorr, Andrew F.

AU - Leroy, Olivier

AU - Petrikos, George

AU - De Rosa, Francesco Giuseppe

PY - 2013/12

Y1 - 2013/12

N2 - 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 amphotericin B 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→3)-β-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 5-7 days of treatment with echinocandins or lipid formulations of amphotericin B, 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.

AB - 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 amphotericin B 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→3)-β-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 5-7 days of treatment with echinocandins or lipid formulations of amphotericin B, 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.

KW - Abdominal infections

KW - Candida

KW - Consensus

UR - http://www.scopus.com/inward/record.url?scp=84888173768&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84888173768&partnerID=8YFLogxK

U2 - 10.1007/s00134-013-3109-3

DO - 10.1007/s00134-013-3109-3

M3 - Article

C2 - 24105327

AN - SCOPUS:84888173768

VL - 39

SP - 2092

EP - 2106

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 12

ER -