Pharmacokinetics of echinocandins in suspected candida peritonitis: A potential risk for resistance
Introduction: A possible increase in Candida resistance, especially in Candida glabrata, has been speculated according to poor diffusion of echinocandins to peritoneal fluid. Materials/methods: Peritoneal and serum concentrations of caspofungin, micafungin and anidulafungin were analysed in surgical...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-12-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971220307347 |
| _version_ | 1818956496869785600 |
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| author | Francesca Gioia Alicia Gomez-Lopez Maria Elena Alvarez Elia Gomez-García de la Pedrosa Pilar Martín-Davila Manuel Cuenca-Estrella Santiago Moreno Jesús Fortun |
| author_facet | Francesca Gioia Alicia Gomez-Lopez Maria Elena Alvarez Elia Gomez-García de la Pedrosa Pilar Martín-Davila Manuel Cuenca-Estrella Santiago Moreno Jesús Fortun |
| author_sort | Francesca Gioia |
| collection | DOAJ |
| description | Introduction: A possible increase in Candida resistance, especially in Candida glabrata, has been speculated according to poor diffusion of echinocandins to peritoneal fluid. Materials/methods: Peritoneal and serum concentrations of caspofungin, micafungin and anidulafungin were analysed in surgical patients with suspected candida peritonitis. After 4 days of starting therapy, serum and peritoneal samples (through peritoneal drainage) were obtained at baseline, 1, 6, 12 and 24 h of drug administration. Micafungin and anidulafungin concentrations were determined using high-performance liquid chromatography (HPLC/F), whereas caspofungin concentrations were established by bioassay. Results: Twenty-three 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 echinocandin. No special clinical differences were observed among the three groups of patients. All were receiving antibiotic therapy, 80% required inotropic drugs, and fungal peritonitis was 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, 0.68–0.88 μg/mL for micafungin and 0.21–0.46 μg/mL for caspofungin. Conclusion: The results showed moderate penetration of echinocandins into the peritoneal fluid of these patients. These levels are below the threshold of resistance mutant selection published by other authors. This could justify a potential risk of resistance in patients with prolonged treatment with echinocandins and suboptimal control of abdominal infection. |
| first_indexed | 2024-12-20T10:54:53Z |
| format | Article |
| id | doaj.art-f3dd0c058aec4a5eb66ee918abebfd3b |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-12-20T10:54:53Z |
| publishDate | 2020-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-f3dd0c058aec4a5eb66ee918abebfd3b2022-12-21T19:43:10ZengElsevierInternational Journal of Infectious Diseases1201-97122020-12-011012428Pharmacokinetics of echinocandins in suspected candida peritonitis: A potential risk for resistanceFrancesca Gioia0Alicia Gomez-Lopez1Maria Elena Alvarez2Elia Gomez-García de la Pedrosa3Pilar Martín-Davila4Manuel Cuenca-Estrella5Santiago Moreno6Jesús Fortun7Infectious Diseases Department, Hospital Ramón y Cajal, Madrid, SpainMycology Department, Centro Nacional de Microbiología, Madrid, SpainInfectious Diseases Department, Hospital Ramón y Cajal, Madrid, SpainMicrobiology Department, Hospital Ramón y Cajal, Madrid, SpainInfectious Diseases Department, Hospital Ramón y Cajal, Madrid, SpainMycology Department, Centro Nacional de Microbiología, Madrid, SpainInfectious Diseases Department, Hospital Ramón y Cajal, Madrid, SpainInfectious Diseases Department, Hospital Ramón y Cajal, Madrid, Spain; Corresponding author.Introduction: A possible increase in Candida resistance, especially in Candida glabrata, has been speculated according to poor diffusion of echinocandins to peritoneal fluid. Materials/methods: Peritoneal and serum concentrations of caspofungin, micafungin and anidulafungin were analysed in surgical patients with suspected candida peritonitis. After 4 days of starting therapy, serum and peritoneal samples (through peritoneal drainage) were obtained at baseline, 1, 6, 12 and 24 h of drug administration. Micafungin and anidulafungin concentrations were determined using high-performance liquid chromatography (HPLC/F), whereas caspofungin concentrations were established by bioassay. Results: Twenty-three 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 echinocandin. No special clinical differences were observed among the three groups of patients. All were receiving antibiotic therapy, 80% required inotropic drugs, and fungal peritonitis was 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, 0.68–0.88 μg/mL for micafungin and 0.21–0.46 μg/mL for caspofungin. Conclusion: The results showed moderate penetration of echinocandins into the peritoneal fluid of these patients. These levels are below the threshold of resistance mutant selection published by other authors. This could justify a potential risk of resistance in patients with prolonged treatment with echinocandins and suboptimal control of abdominal infection.http://www.sciencedirect.com/science/article/pii/S1201971220307347EchinocandinsPharmacokineticsCandidaPeritonitisResistance |
| spellingShingle | Francesca Gioia Alicia Gomez-Lopez Maria Elena Alvarez Elia Gomez-García de la Pedrosa Pilar Martín-Davila Manuel Cuenca-Estrella Santiago Moreno Jesús Fortun Pharmacokinetics of echinocandins in suspected candida peritonitis: A potential risk for resistance International Journal of Infectious Diseases Echinocandins Pharmacokinetics Candida Peritonitis Resistance |
| title | Pharmacokinetics of echinocandins in suspected candida peritonitis: A potential risk for resistance |
| title_full | Pharmacokinetics of echinocandins in suspected candida peritonitis: A potential risk for resistance |
| title_fullStr | Pharmacokinetics of echinocandins in suspected candida peritonitis: A potential risk for resistance |
| title_full_unstemmed | Pharmacokinetics of echinocandins in suspected candida peritonitis: A potential risk for resistance |
| title_short | Pharmacokinetics of echinocandins in suspected candida peritonitis: A potential risk for resistance |
| title_sort | pharmacokinetics of echinocandins in suspected candida peritonitis a potential risk for resistance |
| topic | Echinocandins Pharmacokinetics Candida Peritonitis Resistance |
| url | http://www.sciencedirect.com/science/article/pii/S1201971220307347 |
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