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Outcome of Candida Parapsilosis Complex Infections Treated with Caspofungin in Children
İlker Devrim1, Rana İşgüder1, Hasan Ağın1
1Department of Pediatric Intensive Care Unit, Dr. Behcet Uz Children's Hospital, İzmir, Turkey.
Insights
Caspofungin E-tests showed limited impact on central venous catheter survival in pediatric Candida parapsilosis bloodstream infections. However, caspofungin therapy achieved negative cultures in most patients, with relapses and mortality rates observed.
Area of Science:
- Pediatric Infectious Diseases
- Antifungal Therapy
- Clinical Microbiology
Background:
- Evaluating caspofungin E-tests in pediatric Candida parapsilosis complex bloodstream infections.
- Assessing correlation with prognosis and treatment response in a PICU setting.
Purpose of the Study:
- Determine the relationship between caspofungin E-test results and patient outcomes.
- Analyze treatment efficacy and survival rates in children with C. parapsilosis bloodstream infections.
Main Methods:
- Retrospective study of pediatric patients with C. parapsilosis complex bloodstream infections treated with caspofungin.
- Collected data on blood/CVC cultures, CVC removal, mortality, relapses, and demographics.
Main Results:
- Central venous catheter survival rate was 33.3% under caspofungin.
- Negative cultures achieved in 92.4% within 12.5 days; relapse rate was 18.9%.
- Overall mortality was 37.7%, 30-day mortality 7.5%; no significant difference based on MIC levels.
Conclusions:
- Caspofungin's impact on CVC maintenance in children was limited, despite known anti-biofilm effects.
- Clinicians must consider patient priorities and choose optimal antifungal therapy for C. parapsilosis infections.
Background:
We aimed to evaluate the correlation of caspofungin E-tests with the prognosis and response to caspofungin therapy of Candida parapsilosis complex bloodstream infections in children hospitalized in a pediatric intensive care unit.
Methods:
All children who had C. parapsilosis complex bloodstream infections and who were treated with caspofungin were included in this retrospective study. For each patient, the following parameters, including all consecutive blood and central venous catheter (CVC) cultures, the duration between diagnosis and CVC removal, mortality rate, relapses of the C. parapsilosis complex infections as well as the demographic features, were recorded.
Results:
The central venous catheter survival rate was 33.3% under caspofungin treatment. In 92.4 % of the patients, the negative culture was achieved within a median duration of 12.5 days. The rate of relapses was 18.9%. The overall mortality rate was 37.7% (20 of 53 patients), and the 30-days mortality rate was 7.5% (4 of 53 patients). There was no statistically significant difference between the groups with MIC<2 mg/l and MIC =2 mg/l using CVC survival rate; rate and duration of achieving negative blood culture for C. parapsilosis complex; duration of hospital stay; rate and duration of relapses; overall mortality and 30-days mortality.
Conclusions:
The beneficial effects of Caspofungin on biofilms has been shown in vivo, while its impact in children for maintenance of CVC was limited in our study but should not be underestimated in children who strongly need the presence of CVCs. The clinicians should weigh their priority for their patients and choose the optimal antifungal therapy for C. parapsilosis complex infections in children.
