title: Caspofungin therapy of neonates with invasive candidiasis.
abstract: BACKGROUND
  Invasive candidiasis is an increasing problem in neonatal intensive care units worldwide and is an important cause of morbidity, mortality and prolongation of hospital stay. Despite administration of amphotericin B, invasive candidiasis in neonates is sometimes complicated by persistent fungemia and refractory invasive candidiasis. The problem has been augmented by the increasing prevalence of non-albicans species that often are resistant to fluconazole and to amphotericin B.
  
  
  METHODS
  The population consisted of 1 term and 9 premature neonates with invasive candidiasis caused by Candida albicans (n = 4), Candida parapsilosis (n = 3), Candida tropicalis (n = 2) and Candida glabrata (n = 1). Despite initial therapy with deoxycholate amphotericin B, blood cultures remained positive in all patients for 13-49 days. Invasive candidiasis progressed to meningitis and enlarging renal Candida bezoars in the kidney of one patient and an enlarging atrial vegetation in another. Another patient developed severe hypokalemia refractory to potassium supplementation. Two of the C. albicans and all of the non-albicans Candida isolates were resistant to fluconazole; the C. glabrata isolate was resistant to amphotericin B. Amphotericin B was discontinued and caspofungin initiated in all patients in a dosage of 1 mg/kg/d for 2 days followed by 2 mg/kg/d.
  
  
  RESULTS
  All positive blood cultures cleared between 3 and 7 days after initiation of caspofungin, the atrial vegetation resolved and the renal Candida bezoars disappeared. Renal and hepatic function tests did not show any values above normal throughout caspofungin therapy. There were no attributable clinical adverse events during the administration of caspofungin in any of the patients.
  
  
  CONCLUSIONS
  Caspofungin was effective, safe and well-tolerated as an alternative therapy for persistent and progressive candidiasis in those neonates who were unresponsive to or intolerant of deoxycholate amphotericin B.
authors.affiliation: Infectious Diseases, Hospital Nacional de Niños, San Jose, Costa Rica. Codio@hnn.sa.cr
authors.forename: Carla M
authors.initials: CM
authors.lastname: Odio
authors.forename: Roberto
authors.initials: R
authors.lastname: Araya
authors.forename: Luis E
authors.initials: LE
authors.lastname: Pinto
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Castro
authors.forename: Sergio
authors.initials: S
authors.lastname: Vasquez
authors.forename: Braulio
authors.initials: B
authors.lastname: Alfaro
authors.forename: Alberto
authors.initials: A
authors.lastname: Sàenz
authors.forename: Marco L
authors.initials: ML
authors.lastname: Herrera
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology; D000077336:Caspofungin; D025141:Drug Resistance, Fungal; D054714:Echinocandins; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D055666:Lipopeptides; D008826:Microbial Sensitivity Tests; D010456:Peptides, Cyclic / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D000077336:Caspofungin