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

Bassetti, Matteo; Marchetti, Monia; Chakrabarti, Arunaloke; Colizza, S.; Garnacho-Montero, José; Kett, Daniel H.; Muñóz, 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; Rosa, Francesco Giuseppe De

doi:10.1007/s00134-013-3109-3

Cited by 166 publications

(155 citation statements)

References 77 publications

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“…Despite the lack of randomized trials, antifungal therapy for patients with severe community-acquired or healthcare-associated intra-abdominal infection is recommended if Candida is grown from cultures [9,84].…”

Section: What Are Remaining Areas Of Uncertainty? Invasive Candidiasismentioning

confidence: 99%

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

et al. 2017

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Purpose:To describe concisely the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to Candida and Aspergillus infections in non-neutropenic patients in the ICU setting. Methods:A systematic review of the medical literature taking account of national and international guidelines and expert opinion. Results:Severe invasive fungal infections (IFIs) are becoming increasingly frequent in critically ill patients. Approximately 80% of IFIs are due to Candida spp. and 0.3-19% to Aspergillus spp. Recent observations emphasize the necessity of building a worldwide sentinel network to monitor the emergence of new fungal species and changes in susceptibility. Robust data on the attributable mortality are essential for the design of clinical studies with mortality endpoints. Although early antifungal therapy for Candida has been recommended in patients with risk factors, sepsis of unknown cause, and positive Candida serum biomarkers [β-1 → 3-d-glucan (BDG) and Candida albicans germ tube antibody (CAGTA)], its usefulness and influence on outcome need to be confirmed. Future studies may specifically address the optimal diagnostic and therapeutic strategies for patients with abdominal candidiasis. Better knowledge of the pharmacokinetics of antifungal molecules and tissue penetration is a key issue for intensivists. Regarding invasive aspergillosis, further investigation is needed to determine its incidence in the ICU, its relationship with influenza outbreaks, the clinical impact of rapid diagnosis, and the significance of combination treatment. Conclusions:Fundamental questions regarding IFI have to be addressed over the next decade. The clinical studies described in this research agenda should provide a template and set priorities for the clinical investigations that need to be performed.

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Section: What Are Remaining Areas Of Uncertainty? Invasive Candidiasismentioning

confidence: 99%

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

et al. 2017

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“…Recently, a consensus of multinational experts proposed enhanced recommendations for the management of IAC [7]. Using these criteria, Bassetti et al, in an article recently published in Intensive Care Medicine, reported a retrospective international cohort of 481 patients treated for IAC [8].…”

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confidence: 99%

“…Due to the diversity of clinical manifestations of IAC, future investigators should seek for homogenous populations to more closely address the diagnosis and therapeutic issues of these complex cases. The framework of the multinational consensus brings the opportunity for better definitions and enhanced inclusion/ exclusion criteria [7]. Some specific sub-categories of patients at high risk of IAC could be identified in future trials, illustrated in Table 1.…”

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Intra-abdominal candidiasis: it’s still a long way to get unquestionable data

2015

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Intra-abdominal candidiasis (IAC) appears as the second most frequent cause of invasive fungal infection in the intensive-care unit (ICU) [1]. In the AmarCand 1 study, a prospective, multicenter, French observational study, IAC was observed in 34 % of ICU patients with proven invasive candidiasis [1]. Intra-abdominal candidiasis accounts for more than 10 % of all cases of peritonitis and is associated with mortality rates between 25 and 60 % [2,3].Intra-abdominal candidiasis shares many similarities with candidaemia, including conventional risk factors [4] and high morbidity and mortality rates [2,3,5]. While the need for early and adequate antifungal treatment of candidaemia has been clearly demonstrated, no clinical study has ever assessed the need to treat IAC, raising the question of the real pathogenicity of these organisms.Based on the demonstration that delayed antifungal treatment in candidaemia is a factor of poor prognosis, empirical broad-spectrum antifungal treatment is routinely prescribed in IAC. Interestingly, American and European guidelines do not address this issue while the IDSA guidelines for intra-abdominal infections give only weak therapeutic recommendations [6].Recently, a consensus of multinational experts proposed enhanced recommendations for the management of IAC [7]. Using these criteria, Bassetti et al., in an article recently published in Intensive Care Medicine, reported a retrospective international cohort of 481 patients treated for IAC [8]. The authors should be congratulated for the largest cohort of IAC ever published and for the interesting data presented here. Their results deserve some comments to emphasize the complexity for organizing studies on this topic.Despite their attempt to obtain a homogeneous cohort, there is room for improvement in future trials. Their study population gathered together different clinical situations (secondary and tertiary peritonitis, abdominal abscesses, pancreatitis, etc.) in patients with very different underlying diseases and medical history (hospitalized in ICU and surgical wards but also in medical wards, hematology, oncology, etc.) with different levels of severity (with or without septic shock) related to community-acquired, health care-associated and hospital-acquired infections. Overall, a 49.5 % mortality rate was observed in ICU patients compared to 22.8 % in non-ICU patients. Not surprisingly, septic shock and high APACHE II score appeared as independent predictors of mortality, all the more so in patients with these life-threatening conditions who were not all admitted in ICU.A second important issue in the manuscript of Bassetti et al. is the strong correlation between inadequate source control and increased mortality [8]. These findings confirm what some of the authors have recently published [9]. Interestingly, the issue of source control is a matter of

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“…In their article published in the current issue of Intensive Care Medicine, Bassetti et al [6] propose specific recommendations from a consensus of experts. This laudable attempt is a first and welcome step but, as expected, it also highlights the moderate or low quality of evidence in many fields.…”

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confidence: 99%

“…A large part of the common confusion lies in these different clinical situations, as they complicate the decision-making process of the experts in coming to a consensus regarding the diagnosis and treatment. To improve readability and prioritization of the long list of recommendations provided by Bassetti et al [6], we would like to emphasize several points which may help clinicians identify early those surgical patients who truly would benefit from treatment with.…”

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confidence: 99%

Intra-abdominal candidiasis: the guidelines—forgotten non-candidemic invasive candidiasis

2013

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

Abstract: Specific recommendations were elaborated on IAC management based on the best direct and indirect evidence and on the expertise of a multinational panel.

Cited by 166 publications

References 77 publications

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

Intra-abdominal candidiasis: it’s still a long way to get unquestionable data

Intra-abdominal candidiasis: the guidelines—forgotten non-candidemic invasive candidiasis

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