Penetration of echinocandins into wound secretion of critically ill patients
| Autor: | Thomas Staudinger, Romuald Bellmann, Tobias Santner, Michael Joannidis, Peter Schellongowski, Ingo H. Lorenz, Karin Burgmann, Stephan Eschertzhuber, Jana Marx, Tiziana Gasperetti, René Welte, Andrea Griesmacher, Maria Aigner, Philipp Eller, Hartwig Pfisterer, Herbert Oberacher |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Microbiology (medical) Adult medicine.medical_specialty Antifungal Agents Echinocandin Wound infection Critical Illness 030106 microbiology Microbial Sensitivity Tests Gastroenterology 03 medical and health sciences chemistry.chemical_compound Echinocandin antifungals Echinocandins Lipopeptides 0302 clinical medicine Target-site pharmacokinetics Internal medicine Medicine Humans Secretion Candidiasis Invasive 030212 general & internal medicine Original Paper business.industry Critically ill Micafungin General Medicine Penetration (firestop) bacterial infections and mycoses Invasive candidiasis Infectious Diseases chemistry Anidulafungin Caspofungin business Vacuum assisted closure therapy medicine.drug |
| Zdroj: | Infection |
| ISSN: | 1439-0973 0300-8126 |
| Popis: | Purpose Wound infections caused by Candida are life-threatening and difficult to treat. Echinocandins are highly effective against Candida species and recommended for treatment of invasive candidiasis. As penetration of echinocandins into wounds is largely unknown, we measured the concentrations of the echinocandins anidulafungin (AFG), micafungin (MFG), and caspofungin (CAS) in wound secretion (WS) and in plasma of critically ill patients. Methods We included critically ill adults with an indwelling wound drainage or undergoing vacuum-assisted closure therapy, who were treated with an echinocandin for suspected or proven invasive fungal infection. Concentrations were measured by liquid chromatography with UV (AFG and MFG) or tandem mass spectrometry detection (CAS). Results Twenty-one patients were enrolled. From eight patients, serial WS samples and simultaneous plasma samples were obtained within a dosage interval. AFG concentrations in WS amounted to Conclusion Echinocandin penetration into WS displays a high inter-individual variability. In WS of some of the patients, concentrations may be sub-therapeutic. However, the relevance of sub-therapeutic concentrations is unknown as no correlation has been established between concentration data and clinical outcome. Nevertheless, in the absence of clinical outcome studies, our data do not support the use of echinocandins at standard doses for the treatment of fungal wound infections, but underline the pivotal role of surgical debridement. |
| Databáze: | OpenAIRE |
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