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



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.


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.


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.


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

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Italian Society of Intensive Care


International Society of Chemotherapy


European Society of Clinical Microbiology and Infectious Diseases


Expert panel




intra-abdominal candidiasis


Intensive care unit


Clinical and Laboratory Standards Institute


European Committee on Antimicrobial Susceptibility Testing


C. albicans germ tube antibodies




Infectious Diseases Society of America


Central nervous system


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Conflicts of interest

M.B. serves on scientific advisory boards for Pfizer Inc., Merck Serono, and Astellas Pharma Inc. and has received funding for travel or speaker honoraria from Pfizer Inc., Merck Serono, Gilead Sciences, Teva Inc., and Astellas Pharma Inc. C.T. has been paid for lectures and advisory boards for Pfizer, Novartis, Merck, Astellas, Gilead, Angelini, and Zambon Group. F.G.D.R., F.C., G.S., A.C., and M.T. have been speakers or consultants for Gilead Sciences, MSD, and Pfizer. T.J.W. has received research grants from Astellas, Novartis, Merck, ContraFect, and Pfizer and has been speaker or consultant for Astellas, ContraFect, Drais, iCo, Novartis, Pfizer, Methylgene, SigmaTau, and Trius. C.E. has served on advisory boards and received speaker honoraria from Pfizer Inc., Astellas Pharma Inc., and MSD. G.P. has received research grants from Gilead, Pfizer, Astellas, and MSD, has acted as paid consultant to Astellas, Gilead, and MSD, and is a member of the Astellas and MSD speaker’s bureaus. C.V. received grants as speaker/moderator in meetings sponsored by Pfizer, Gilead, MSD, Astellas, Abbott, Nadirex International, and BMS and received grants for participation in advisory boards by Gilead, Astellas, MSD, and Pfizer. Further, he obtained research grants for his institution from Pfizer, MSD, Gilead, Abbott, Jansen, BMS, and Novartis. D.H.K. serves as a consultant to and on scientific advisory boards for Pfizer Inc. and has received funding for travel or speaker honoraria from Pfizer Inc. The other authors serve on scientific advisory board of MSD. O.L. serves on scientific advisory boards for MSD and Astellas Pharma Inc. and has received speaker honoraria from Sanofi Aventis, Pfizer Inc., MSD, and Astellas Pharma Inc.

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Correspondence to Matteo Bassetti.

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Take-home message: A group of clinical experts endorsed by the Italian Society of Intensive Care and the International Society of Chemotherapy elaborated specific statements and practice recommendations addressing the management of intra-abdominal invasive candidiasis based on the best direct and indirect evidence. International guidelines do not specifically address this particular clinical setting and scant direct evidence is available.

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Bassetti, M., Marchetti, M., Chakrabarti, A. et al. A research agenda on the management of intra-abdominal candidiasis: results from a consensus of multinational experts. Intensive Care Med 39, 2092–2106 (2013). https://doi.org/10.1007/s00134-013-3109-3

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  • Candida
  • Abdominal infections
  • Consensus