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The Role of Candida in Abdominal Sepsis

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Abdominal Sepsis

Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

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Abstract

The management of intra-abdominal candidiasis is a challenging issue. Differentiation between colonization and infection is a complex process, which has led to the development of several clinical scores and non-microbiologic tools over recent years. The distinction between colonization and infection is of major importance, as Candida infection is a proven risk factor for mortality in critically ill patients and patients with postoperative peritonitis. The most common pathogens cultured from surgical samples are Candida albicans and, among Candida non-albicans species, C. glabrata, and both of these organisms are also gut commensals in healthy subjects. However, candidemia is rare in these cases. The key issues for the management of these difficult cases are time efficiency and quality of both surgical and medical therapy. Source control is obviously a crucial factor, and the efficacy of source control is reinforced by antifungal therapy. Adequate antifungal therapy requires correct timing, an efficient spectrum, and the right dosage. In critically ill patients and those suspected of harboring azole-resistant strains, a general agreement among the experts and most of the recently published consensus recommends the use of echinocandins, while fluconazole is reserved for low-severity cases and patients with no previous antifungal therapy. Antifungal stewardship is based on de-escalation therapy when possible and limited duration of treatment.

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References

  1. Bassetti M, Righi E, Ansaldi F, et al. A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality. Intensive Care Med. 2015;41:1601–10.

    Article  PubMed  Google Scholar 

  2. 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. 2013;39:2092–106.

    Article  PubMed  Google Scholar 

  3. Knoke M. Gastrointestinal microecology of humans and Candida. Mycoses. 1999;42(Suppl 1):30–4.

    Article  PubMed  Google Scholar 

  4. Sawyer RG, Adams RB, May AK, et al. Development of Candida albicans and C. albicans/Escherichia coli/Bacteroides fragilis intraperitoneal abscess models with demonstration of fungus-induced bacterial translocation. J Med Vet Mycol. 1995;33:49–52.

    Article  CAS  PubMed  Google Scholar 

  5. De Waele J, Lipman J, Sakr Y, et al. Abdominal infections in the intensive care unit: characteristics, treatment and determinants of outcome. BMC Infect Dis. 2014;14:420.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Dupont H, Paugam-Burtz C, Muller-Serieys C, et al. Predictive factors of mortality due to polymicrobial peritonitis with Candida isolation in peritoneal fluid in critically ill patients. Arch Surg. 2002;137:1341–6. discussion 1347

    Article  PubMed  Google Scholar 

  7. Klingspor L, Tortorano AM, Peman J, et al. Invasive Candida infections in surgical patients in intensive care units: a prospective, multicentre survey initiated by the European Confederation of Medical Mycology (ECMM) (2006–2008). Clin Microbiol Infect. 2015;21:87.e1–87.e10.

    Article  CAS  Google Scholar 

  8. Montravers P, Dupont H, Gauzit R, et al. Candida as a risk factor for mortality in peritonitis. Crit Care Med. 2006;34:646–52.

    Article  PubMed  Google Scholar 

  9. Sartelli M, Catena F, Ansaloni L, et al. Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study. World J Emerg Surg. 2014;9:37.

    Article  PubMed  PubMed Central  Google Scholar 

  10. De Ruiter J, Weel J, Manusama A, et al. The epidemiology of intra-abdominal flora in critically ill patients with secondary and tertiary abdominal sepsis. Infection. 2009;37:522–7.

    Article  PubMed  Google Scholar 

  11. Rebibo L, Dupont H, Levrard M, et al. Letter to editor: “Gastric fistula after laparoscopic sleeve gastrectomy: don't forget to treat for Candida”. Obes Surg. 2013;23:2106–8.

    Article  PubMed  Google Scholar 

  12. Zappella N, Desmard M, Chochillon C, et al. Positive peritoneal fluid fungal cultures in postoperative peritonitis after bariatric surgery. Clin Microbiol Infect. 2015;21:853.e1–3.

    Article  CAS  Google Scholar 

  13. Montravers P, Dufour G, Guglielminotti J, et al. Dynamic changes of microbial flora and therapeutic consequences in persistent peritonitis. Crit Care. 2015;19:70.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Vergidis P, Clancy CJ, Shields RK, et al. Intra-abdominal candidiasis: the importance of early source control and antifungal treatment. PLoS One. 2016;11:e0153247.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Montravers P, Perrigault PF, Timsit JF, et al. Antifungal therapy for patients with proven or suspected Candida peritonitis : Amarcand2, a prospective cohort study in French intensive care units. Clin Microbiol Infect. 2017;23(2):117.e1–8.

    Article  CAS  Google Scholar 

  16. Puig-Asensio M, Peman J, Zaragoza R, et al. Impact of therapeutic strategies on the prognosis of candidemia in the ICU. Crit Care Med. 2014;42:1423–32.

    Article  CAS  PubMed  Google Scholar 

  17. Riche F, Dray X, Laisne MJ, et al. Factors associated with septic shock and mortality in generalized peritonitis; comparison between community-acquired and postoperative peritonitis. Crit Care. 2009;13:R99.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Sandven P, Qvist H, Skovlund E, et al. Significance of Candida recovered from intraoperative specimens in patients with intra-abdominal perforations. Crit Care Med. 2002;30:541–7.

    Article  PubMed  Google Scholar 

  19. Lee SC, Fung CP, Chen HY, et al. Candida peritonitis due to peptic ulcer perforation: incidence rate, risk factors, prognosis and susceptibility to fluconazole and amphotericin B. Diagn Microbiol Infect Dis. 2002;44:23–7.

    Article  PubMed  Google Scholar 

  20. Shan YS, Hsu HP, Hsieh YH, et al. Significance of intraoperative peritoneal culture of fungus in perforated peptic ulcer. Br J Surg. 2003;90:1215–9.

    Article  PubMed  Google Scholar 

  21. Cornely OA, Bassetti M, Calandra T, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect. 2012;18(Suppl 7):19–37.

    Article  CAS  PubMed  Google Scholar 

  22. Leon C, Ostrosky-Zeichner L, Schuster M. What’s new in the clinical and diagnostic management of invasive candidiasis in critically ill patients. Intensive Care Med. 2014;40:808–19.

    Article  CAS  PubMed  Google Scholar 

  23. Montravers P, Mira JP, Gangneux JP, et al. A multicentre study of antifungal strategies and outcome of Candida spp. peritonitis in intensive-care units. Clin Microbiol Infect. 2011;17:1061–7.

    Article  CAS  PubMed  Google Scholar 

  24. Nguyen MH, Wissel MC, Shields RK, et al. Performance of Candida real-time polymerase chain reaction, beta-d-glucan assay, and blood cultures in the diagnosis of invasive candidiasis. Clin Infect Dis. 2012;54:1240–8.

    Article  CAS  PubMed  Google Scholar 

  25. Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of Candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62:e1–50.

    Article  PubMed  Google Scholar 

  26. Azoulay E, Dupont H, Tabah A, et al. Systemic antifungal therapy in critically ill patients without invasive fungal infection. Crit Care Med. 2012;40:813–22.

    Article  CAS  PubMed  Google Scholar 

  27. Dupont H, Bourichon A, Paugam-Burtz C, et al. Can yeast isolation in peritoneal fluid be predicted in intensive care unit patients with peritonitis? Crit Care Med. 2003;31:752–7.

    Article  PubMed  Google Scholar 

  28. Leon C, Ruiz-Santana S, Saavedra P, et al. Usefulness of the “Candida score” for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: a prospective multicenter study. Crit Care Med. 2009;37:1624–33.

    Article  PubMed  Google Scholar 

  29. Ostrosky-Zeichner L, Sable C, Sobel J, et al. Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting. Eur J Clin Microbiol Infect Dis. 2007;26:271–6.

    Article  CAS  PubMed  Google Scholar 

  30. Ostrosky-Zeichner L, Pappas PG, Shoham S, et al. Improvement of a clinical prediction rule for clinical trials on prophylaxis for invasive candidiasis in the intensive care unit. Mycoses. 2011;54:46–51.

    Article  PubMed  Google Scholar 

  31. Pittet D, Monod M, Suter PM, et al. Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg. 1994;220:751–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Dupont H, Guilbart M, Ntouba A, et al. Can yeast isolation be predicted in complicated secondary non-postoperative intra-abdominal infections? Crit Care. 2015;19:60.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Leon C, Ruiz-Santana S, Saavedra P, et al. A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med. 2006;34:730–7.

    Article  PubMed  Google Scholar 

  34. Delaloye J, Calandra T. Invasive candidiasis as a cause of sepsis in the critically ill patient. Virulence. 2014;5:161–9.

    Article  PubMed  Google Scholar 

  35. Eggimann P, Pittet D. Candida colonization index and subsequent infection in critically ill surgical patients: 20 years later. Intensive Care Med. 2014;40:1429–48.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Leon C, Ruiz-Santana S, Saavedra P, et al. Value of beta-d-glucan and Candida albicans germ tube antibody for discriminating between Candida colonization and invasive candidiasis in patients with severe abdominal conditions. Intensive Care Med. 2012;38:1315–25.

    Article  CAS  PubMed  Google Scholar 

  37. Tissot F, Lamoth F, Hauser PM, et al. Beta-glucan antigenemia anticipates diagnosis of blood culture-negative intra-abdominal candidiasis. Am J Respir Crit Care Med. 2013;188(9):1100–9.

    Article  PubMed  Google Scholar 

  38. Leon C, Ruiz-Santana S, Saavedra P, et al. Contribution of Candida biomarkers and DNA detection for the diagnosis of invasive candidiasis in ICU patients with severe abdominal conditions. Crit Care. 2016;20:149.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Martinez-Jimenez MC, Munoz P, Valerio M, et al. Combination of Candida biomarkers in patients receiving empirical antifungal therapy in a Spanish tertiary hospital: a potential role in reducing the duration of treatment. J Antimicrob Chemother. 2015;70:3107–15.

    Article  CAS  PubMed  Google Scholar 

  40. Corrales I, Gimenez E, Aguilar G, et al. Detection of fungal DNA in peritoneal fluids by a PCR DNA low-density microarray system and quantitation of serum (1-3)-beta-d-glucan in the diagnosis of peritoneal candidiasis. Med Mycol. 2015;53:199–204.

    Article  CAS  PubMed  Google Scholar 

  41. Bassetti M, Righi E, Ansaldi F, et al. A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality. Intensive Care Med. 2014;40:839–45.

    Article  CAS  PubMed  Google Scholar 

  42. Kollef M, Micek S, Hampton N, et al. Septic shock attributed to Candida infection: importance of empiric therapy and source control. Clin Infect Dis. 2012;54:1739–46.

    Article  CAS  PubMed  Google Scholar 

  43. Garey KW, Rege M, Pai MP, et al. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. Clin Infect Dis. 2006;43:25–31.

    Article  CAS  PubMed  Google Scholar 

  44. Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother. 2005;49:3640–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Knitsch W, Vincent JL, Utzolino S, et al. A randomized, placebo-controlled trial of preemptive antifungal therapy for the prevention of invasive candidiasis following gastrointestinal surgery for intra-abdominal infections. Clin Infect Dis. 2015;61:1671–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  46. EUCAST Clinical breakpoints (Bacterial v 6.0 and Fungal v 8.0). http://www.eucast.org/clinical_breakpoints.accessed. 25 Oct 2016.

  47. Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:133–64.

    Article  PubMed  Google Scholar 

  48. Sartelli M, Viale P, Catena F, et al. 2013 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2013;8:3.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Montravers P, Dupont H, Leone M, et al. Guidelines for management of intra-abdominal infections. Anaesth Crit Care Pain Med. 2015;34:117–30.

    Article  PubMed  Google Scholar 

  50. Mora-Duarte J, Betts R, Rotstein C, et al. Comparison of caspofungin and amphotericin B for invasive candidiasis. N Engl J Med. 2002;347:2020–9.

    Article  CAS  PubMed  Google Scholar 

  51. Pappas PG, Rotstein CM, Betts RF, et al. Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis. Clin Infect Dis. 2007;45:883–93.

    Article  CAS  PubMed  Google Scholar 

  52. Kuse ER, Chetchotisakd P, da Cunha CA, et al. Micafungin versus liposomal amphotericin B for candidaemia and invasive candidosis: a phase III randomised double-blind trial. Lancet. 2007;369:1519–27.

    Article  CAS  PubMed  Google Scholar 

  53. Reboli AC, Rotstein C, Pappas PG, et al. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med. 2007;356:2472–82.

    Article  CAS  PubMed  Google Scholar 

  54. Sinnollareddy MG, Roberts JA, Lipman J, et al. Pharmacokinetic variability and exposures of fluconazole, anidulafungin, and caspofungin in intensive care unit patients: data from multinational Defining Antibiotic Levels in Intensive care unit (DALI) patients study. Crit Care. 2015;19:33.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Grau S, Luque S, Campillo N, et al. Plasma and peritoneal fluid population pharmacokinetics of micafungin in post-surgical patients with severe peritonitis. J Antimicrob Chemother. 2015;70:2854–61.

    Article  CAS  PubMed  Google Scholar 

  56. Montravers P, Augustin P, Grall N, et al. Characteristics and outcomes of anti-infective de-escalation during health care-associated intra-abdominal infections. Crit Care. 2016;20:83.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Blot S, De Waele JJ. Critical issues in the clinical management of complicated intra-abdominal infections. Drugs. 2005;65:1611–20.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Paris Diderot Sorbonne Cite University, Paris, France

    Philippe Montravers M.D., Ph.D., Claire Geneve M.D. & Mouna Ben Rehouma M.D.

  2. Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP, Paris, France

    Philippe Montravers M.D., Ph.D., Aurélie Snauwaert M.D., Claire Geneve M.D. & Mouna Ben Rehouma M.D.

  3. Département d’Anesthésie-Réanimation, CHU Bichat Claude Bernard, INSERM UMR1152, Paris, France

    Philippe Montravers M.D., Ph.D.

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  1. Philippe Montravers M.D., Ph.D.
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  2. Aurélie Snauwaert M.D.
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  3. Claire Geneve M.D.
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Correspondence to Philippe Montravers M.D., Ph.D. .

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Editors and Affiliations

  1. Department of Surgery, Macerata Hospital, Macerata, Italy

    Massimo Sartelli

  2. University of Udine, Infectious Diseases Division , Udine, Italy

    Matteo Bassetti

  3. St James's University Hospital, Trinity Centre for Health Sciences , Dublin, Ireland

    Ignacio Martin-Loeches

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Montravers, P., Snauwaert, A., Geneve, C., Rehouma, M.B. (2018). The Role of Candida in Abdominal Sepsis. In: Sartelli, M., Bassetti, M., Martin-Loeches, I. (eds) Abdominal Sepsis. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-319-59704-1_19

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  • DOI: https://doi.org/10.1007/978-3-319-59704-1_19

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