Evidence map›Paper›PMID 33877638›Full record

ArticleInfection2021

Penetration of echinocandins into wound secretion of critically ill patients.

Tiziana Gasperetti, René Welte, Herbert Oberacher, Jana Marx, Ingo Lorenz, Peter Schellongowski, Thomas Staudinger, Karin Burgmann, Philipp Eller, Tobias Santner and 6 more

Open access · hybridAbstract read
In one paragraph

Article in Infection, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
0.2field-weighted citation impact, top 47% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it, 4 citations in OpenAlex.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 5 institutions in 1 country.

Tiziana GasperettiClinical Pharmacokinetics Unit, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
René WelteClinical Pharmacokinetics Unit, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Herbert OberacherInstitute of Legal Medicine and Core Facility Metabolomics, Medical University of Innsbruck, Innsbruck, Austria.
Jana MarxClinical Pharmacokinetics Unit, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Ingo LorenzGeneral and Surgical ICU, University Hospital for Anaesthesia and Intensive Care, Medical University of Innsbruck, Innsbruck, Austria.
Peter SchellongowskiIntensive Care Unit, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
Thomas StaudingerIntensive Care Unit, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
Karin BurgmannIntensive Care Unit, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
Philipp EllerIntensive Care Unit, Department of Internal Medicine, University Hospital of Graz, Graz, Austria.
Tobias SantnerCentral Institute for Medical and Chemical Laboratory Diagnostics, Innsbruck General Hospital, Innsbruck, Austria.
Andrea GriesmacherCentral Institute for Medical and Chemical Laboratory Diagnostics, Innsbruck General Hospital, Innsbruck, Austria.
Hartwig PfistererCentral Institute for Medical and Chemical Laboratory Diagnostics, Innsbruck General Hospital, Innsbruck, Austria.
Stephan EschertzhuberTransplant ICU, University Hospital for Anaesthesia and Intensive Care, Innsbruck General Hospital and Innsbruck Medical University Innsbruck, Innsbruck, Austria.
Maria AignerInstitute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria.
Michael JoannidisDivision of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria.
Romuald BellmannClinical Pharmacokinetics Unit, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. romuald.bellmann@i-med.ac.at.ORCID http://orcid.org/0000-0003-2861-3258
Innsbruck Medical University · ATMedical University of Vienna · ATUniversity Hospital Innsbruck · ATGraz University Hospital · ATUniversität Innsbruck · AT

Funding

Austrian Science Fund KLI 565-B3Austrian Science Fund FWF KLI 565
6 · The paper itself

Abstract

purposeWound 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.

methodsWe 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).

resultsTwenty-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.

conclusionEchinocandin 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.

Indexed as

Candidiasis, InvasiveEchinocandinsAdultAntifungal AgentsCritical IllnessHumansLipopeptidesMicrobial Sensitivity TestsAntifungal AgentsEchinocandinsLipopeptidesEchinocandin antifungalsInvasive candidiasisTarget-site pharmacokineticsVacuum assisted closure therapyWound infection

Identifiers

PMID33877638
PMCPMC8316195
OpenAlexW3155112193

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.