Antifungal drug penetration in soft tissue abscesses: a comparative analysis

氟康唑 卡斯波芬金 伊曲康唑 抗真菌药 两性霉素B 软组织 泊沙康唑 药品 白色念珠菌 药代动力学 抗真菌 抗真菌药 药效学 医学 微生物学 药理学 生物 病理
作者
Alicia Cancela Costa,Antonios Kritikos,Emmanouil Glampedakis,Jorge Da Silva Pereira Clara,Fabian Schaller,Thomas Mercier,Ruth H. Strasser,Zisis Balmpouzis,Angela Koutsokera,Oriol Manuel,Thierry Buclin,Laurent A. Décosterd,Frédéric Lamoth
出处
期刊:Journal of Antimicrobial Chemotherapy [Oxford University Press]
标识
DOI:10.1093/jac/dkae162
摘要

Abstract Background Invasive fungal infections (IFIs) are severe and difficult-to-treat infections affecting immunocompromised patients. Antifungal drug penetration at the site of infection is critical for outcome and may be difficult to achieve. Data about antifungal drug distribution in infected human tissues under real circumstances of IFI are scarce. Methods Multiple samples were obtained from soft tissue abscesses of a lung transplant patient with Candida albicans invasive candidiasis who underwent recurrent procedures of drainage, while receiving different consecutive courses of antifungal therapy [itraconazole (ITC), fluconazole, caspofungin]. Antifungal drug concentrations were measured simultaneously at the site of infection (surrounding inflammatory tissue and fluid content of the abscess) and in plasma for calculation of the tissue/plasma ratio (R). The concentration within the infected tissue was interpreted as appropriate if it was equal or superior to the MIC of the causal pathogen. Results A total of 30 tissue samples were collected for measurements of ITC (n = 12), fluconazole (n = 17) and caspofungin (n = 1). Variable concentrations were observed in the surrounding tissue of the lesions with median R of 2.79 (range 0.51–15.9) for ITC and 0.94 (0.21–1.37) for fluconazole. Concentrations ranges within the fluid content of the abscesses were 0.39–1.83 for ITC, 0.66–1.02 for fluconazole and 0.23 (single value) for caspofungin. The pharmacodynamic target (tissue concentration ≥ MIC) was achieved in all samples for all three antifungal drugs. Conclusions This unique dataset of antifungal drug penetration in infected human soft tissue abscesses suggests that ITC, fluconazole and caspofungin could achieve appropriate concentrations in soft tissue abscesses.
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