Role of Antifungal Therapy in Complicated Intra-abdominal Infections

Abstract

In this narrative review, we discuss key questions about the antifungal treatment of complicated intrabdominal infections (cIAI). Although less common than bacteria, Candida spp. are not an infrequent cause of cIAI. Considering that invasive abdominal candidiasis (IAC) may be accompanied by septic shock in up to 40% of cases, empirical antifungal treatment should be considered while waiting for rapid tests and cultures results, and it should be guided by the presence of risk factors for invasive candidiasis in patients with consistent signs and symptoms. Early antifungal therapy before availability of culture results can be partly based on the results of rapid diagnostic tests such as antigen/antibody assays or other rapid methods, although it should be noted that most data pertaining to the use of rapid tests refer to candidemia or invasive candidiasis in general, and not specifically to IAC, thus clinical judgment still remains crucial. Although cultures are hampered by a slow turnaround time, they remain of paramount importance, by allowing identification at species level and antifungal susceptibility testing. Together with source control, adequate antifungal therapy is an essential component of the correct approach to IAC. Future research should focus on enriching our knowledge on the diagnostic performance of rapid tests in cIAI, and on providing a standardized definition for IAC. Advancements in these fields are crucial for improving the correct use of antifungals at the bedside of cIAI patients and also for reducing unnecessary antifungal use in line with antifungal stewardship principles.