Penetration of echinocandins into wound secretion of critically ill patients.
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...
| Publicado en: | Infection Vol. 49; no. 4; pp. 747 - 756 |
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| Autores principales: | , , , , , , , , , , , , , , , |
| Formato: | clinical trial research tables/charts Journal Article |
| Publicado: |
Springer Nature
Aug2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=151628571&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 151628571 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 03008126 NXO jtl: Infection issn: 03008126 maglogo: N pubinfo: dt: Aug2021 vid: 49 iid: 4 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 151628571 149899845 151628571 151628571 10.1007/s15010-021-01604-x 151628571 ppf: 747 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Penetration of echinocandins into wound secretion of critically ill patients. aug: au: Gasperetti, Tiziana Welte, René Oberacher, Herbert Marx, Jana Lorenz, Ingo Schellongowski, Peter Staudinger, Thomas Burgmann, Karin Eller, Philipp Santner, Tobias Griesmacher, Andrea Pfisterer, Hartwig Eschertzhuber, Stephan Aigner, Maria Joannidis, Michael Bellmann, Romuald affil: Clinical Pharmacokinetics Unit, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria sug: subj: Critically Ill Patients Mycoses Drug Therapy Peptides Pharmacokinetics Antifungal Agents Pharmacokinetics Secretions Human Negative Pressure Wound Therapy Chromatography, Liquid Mass Spectrometry Caspofungin Therapeutic Use Wound Infection Clinical Trials ab: 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 < 0.025–2.25 mg/L, MFG concentrations were 0.025–2.53 mg/L, and CAS achieved concentrations of 0.18–4.04 mg/L. Concentrations in WS were significantly lower than the simultaneous plasma concentrations and below the MIC values of some relevant pathogens. 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. pubtype: Academic Journal doctype: clinical trial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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