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Experience with caspofungin in the treatment of persistent fungemia in neonates
Girija Natarajan1, Mirjana Lulic-Botica, Chokechai Rongkavilit
1Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI 48201, USA.
Objective:
To review our experience of caspofungin in the treatment of persistent candidemia in the neonatal intensive care unit.
Study Design:
This was a retrospective chart review on 13 infants in whom caspofungin was added to conventional antifungals (amphotericin B and/or fluconazole or flucytosine) for the treatment of refractory candidemia.
Results:
A total of 12 infants were preterm (gestational age, 24 to 28 weeks) and one was term; the median birth weight was 800 g (range, 530 to 5600 g). Candidemia (Candida albicans in five, C. parapsilosis in six, C. albicans and C. parapsilosis in one and C. tropicalis in one) persisted despite 6 to 30 days of conventional antifungal therapy. After the addition of caspofungin, sterilization of blood cultures was achieved in 11 infants at the median time of 3 days (range, 1 to 21 days). Adverse events included thrombophlebitis (one patient), hypokalemia (two patients) and elevation of liver enzymes (four patients). Three infants had a second episode of candidemia and seven patients died.
Conclusion:
Caspofungin may be an efficacious addition for treatment of candidemia refractory to conventional antifungal therapy. This drug should be further investigated in neonates.
Insights
Caspofungin effectively treated persistent candidemia in neonates when conventional antifungals failed. Further investigation is warranted for this important antifungal in neonatal intensive care units.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Persistent candidemia poses a significant threat to neonates, particularly in the neonatal intensive care unit (NICU).
- Conventional antifungal therapies often prove insufficient for refractory cases, necessitating alternative treatment strategies.
Purpose of the Study:
- To evaluate the efficacy and safety of caspofungin as an adjunctive therapy for persistent candidemia in a neonatal intensive care unit.
- To assess the outcomes of premature infants treated with caspofungin for refractory fungal infections.
Main Methods:
- A retrospective chart review of 13 infants with persistent candidemia was conducted.
- Caspofungin was added to existing antifungal regimens (amphotericin B, fluconazole, or flucytosine) for infants with refractory infections.
- Blood cultures and adverse events were monitored to assess treatment response and safety.
Main Results:
- Eleven of 13 infants achieved blood culture sterilization after caspofungin addition, with a median time of 3 days.
- The study population consisted primarily of preterm infants (12/13) with a median birth weight of 800g.
- Adverse events included thrombophlebitis, hypokalemia, and elevated liver enzymes; seven infants died, and three experienced a second candidemia episode.
Conclusions:
- Caspofungin demonstrates potential efficacy as an addition to conventional antifungal therapy for refractory candidemia in neonates.
- Further clinical investigation of caspofungin in neonatal populations is recommended due to promising results in this cohort.
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