Antifungal lock therapy with combined 70% ethanol and micafungin in a critically ill infant

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Pharmacology

Background:

• Central venous catheters are essential for neonatal care but pose infection risks.
• Catheter-related candidemia is a serious complication in neonates, often requiring catheter removal.
• Lock therapy, using antimicrobial solutions in the catheter lumen, is explored to preserve catheters during infection.

Observation:

• A neonate developed catheter-related candidemia despite systemic antifungal treatment.
• Standard systemic therapy failed to clear the fungal bloodstream infection.
• The patient required an alternative treatment strategy to resolve the infection.

Findings:

• Combined therapy of ethanol 70% lock solution and micafungin sodium was administered.
• Blood cultures became sterile after the introduction of lock therapy.
• Successful eradication of candidemia was achieved while maintaining catheter patency.

Implications:

• Ethanol lock therapy may be a viable option for treating neonatal candidemia, potentially avoiding catheter removal.
• This approach could reduce treatment costs and complications associated with catheter replacement.
• Further research is warranted to establish optimal protocols and efficacy in larger neonatal populations.