Clinical impact of the fungicidal activity of caspofungin administered alone or in combination in critically ill patients with severe abdominal candidiasis refractory to conventional antifungal drugs: case studies and critical review of the problem.
We discuss two cases of abdominal candidiasis in critically ill patients with multiple organ failure and sepsis. Microbiological and clinical courses remained unresponsive to apparently appropriate antifungal therapy with azole or polyene derivatives. Both microbiological and clinical outcomes dramatically improved after starting caspofungin therapy. Lack of cross-resistance, lack of toxicity and potent fungicidal activity make caspofungin a very attractive drug in life threatening abdominal candidiasis. The optimal treatment of life threatening candidiasis remains a controversial issue. Because of recent advances in the field, we propose a critical review of the problem of refractory candidiasis.
Canivet
J L
JL
Service de Soins Intensifs Généraux, Centre Hospitalier Universitaire Domaine universitaire du Sart-Tilman, B-4000 Liège. Jean-Luc.Canivet@chu.ulg.ac.be
D000005:Abdomen / Q000382:microbiology*; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology; D000077336:Caspofungin; D016638:Critical Illness; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D054714:Echinocandins; D005260:Female; D006801:Humans; D055666:Lipopeptides; D009102:Multiple Organ Failure / Q000188:drug therapy / Q000382:microbiology; D010455:Peptides / Q000008:administration & dosage / Q000627:therapeutic use*; D010456:Peptides, Cyclic; D018805:Sepsis / Q000188:drug therapy / Q000382:microbiology; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010455:Peptides; D010456:Peptides, Cyclic; D000077336:Caspofungin