Peritonitis Clinical Trial
Official title:
Performance of Clinical and Biological Diagnostic Tests in Reference to the Recommended Tests for the Management of Fungal Peritonitis in Intensive Care
Fungal peritonitis accounts for nearly 70% of invasive candidiasis in surgical resuscitation.
Their mortality is high, around 38% and their morbidity also with an increase in length of
stay in intensive care, invasive ventilation times and an increase in the number of surgical
revisions.
Currently, diagnostic and therapeutic management is based on clinical prognostic scores, of
which the "Peritonitis score" (PS) is still used as a reference. These scores are intended to
best target a population eligible for probabilistic antifungal treatment pending the
confirmation or not of the fungal characteristic of peritonitis by the fungal culture (Gold
Standard). In case of severe peritonitis, if the PS is> or = to 3, the clinician must start a
broad-spectrum antifungal treatment which will be continued if the culture of the peritoneal
fluid is positive to yeast. If it is <3, it is not recommended to introduce an anti-fungal
outside of very particular cases. In this situation, an anti-fungal treatment is only started
if the direct examination of the peritoneal liquid made within 24 hours is positive to yeast
or, failing this, to the reception of a positive culture several days later.
However, recent reviews of the "Peritonitis score" have emerged from the analysis of the
"fungal peritonitis" subgroup of the AmarCand II study (underestimation in particular) ,
highlighting the difficulty of identifying this target population. In addition, none of these
clinical scores have demonstrated superiority in guiding probabilistic antifungal therapy.
Direct examination of peritoneal fluid also suffers from low sensitivity.
New diagnostic approaches using, among other things, blood markers (panfungal PCR,
1,3-Beta-D-glucan, etc.) have developed in recent years. In particular, 1,3-Beta-D-glucan has
demonstrated superiority to the candida score in the early diagnosis of intra-abdominal
candidiasis. [8]. His main interest lies in his strong Negative predictive value. The
association of these markers is another way of working to improve their diagnostic
performance. The use of these blood markers is encouraged by European and international
consensus, however, their dosage in the peritoneal fluid is still under study.
One of the consequences of these diagnostic difficulties is the occurrence of inadequate
prescriptions of antifungals in more than 40% of cases of fungal peritonitis in intensive
care, or even more than 70% of cases in the case of any type of candidiasis. invasive.
The investigators therefore seek to study the diagnostic performance of fungal markers (BDG
and PCR) increasingly realized in CHRU de Nancy in reference to the recommended tests
(clinical (PS) and microbiological (ED and culture))
n/a
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