Please use this identifier to cite or link to this item:http://hdl.handle.net/20.500.12105/11082
Pharmacokinetics of Echinocandins in Suspected Candida Peritonitis: a Potential Risk for Resistance.
Int J Infect Dis . 2020 Sep 13;S1201-9712(20)30734-7.
A possible increase of Candida resistance, specially in C. glabrata, has been speculated according to a poor diffusion of echinocandins to peritoneal fluid. Peritoneal and serum concentrations of Caspofungin, micafungin and anidulafungin were analyzed in surgical patients with suspected candida peritonitis. After four days of starting therapy serum and peritoneal samples (through peritoneal drainage) were obtained at baseline, 1 h, 6 h, 12 h, and 24 h of drug administration. Micafungin and anidulafungin concentrations were determined using high-performance liquid chromatography (HPLC/F), whereas caspofungin concentration were stablished by bioassay. A total of 23 critically ill patients with suspected abdominal fungal infection who were receiving an echinocandin were prospectively recruited. No specific criteria were applied to prescribe one specific echinocadin. No special clinical differences were observed among the 3 groups of patients. All were receiving antibiotic therapy, 80% required inotropic drugs and finally fungal peritonitis were confirmed in 74% of them. The AUC0_24h (mg*h/L) obtained in serum and peritoneal fluid were: 126.84 and 34.38; 98.52 and 18.83; and 66.9 and 8.78 for anidulafungin, micafungin and caspofungin, respectively. The median concentration in peritoneal fluid ranged from 0.66 to 1.82 μg/ml for anidulafungin, 0.68 to 0.88 μg/mL for micafungin and 0.21 to 0.46 μg/ml for caspofungin. The results show a moderate penetration of echinocandins into the peritoneal fluid in these patients. These levels are below the threshold of resistance mutant selection published by other authors. It could justify a potential risk of resistance in patients with prolonged treatments with echinocandins and suboptimal control of the abdominal infection.
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