title: Caspofungin for invasive candidiasis at a tertiary care medical center.
abstract: BACKGROUND
  Caspofungin is emerging as first-line therapy for invasive candidiasis. Data on the use of caspofungin for treatment for invasive candidiasis are limited to clinical trials and case reports. We report a single-center experience with 104 consecutive courses of caspofungin for the treatment of invasive candidiasis to evaluate a real-world performance of this drug.
  
  
  METHODS
  A retrospective chart review of patients receiving caspofungin at a tertiary care medical center was performed. Patient information and microbiologic data were abstracted from patient charts and electronic medical records.
  
  
  RESULTS
  Of 241 patients receiving caspofungin for all indications, 122 (51%) had proven invasive candidiasis. There were 104 treatment courses for candidiasis in 99 patients available for review. Bloodstream (66%) and abdominal infections (25%) were the most common sites of infection. Most infections were non-albicans (80/104, 77%; including patients infected with more than one species). Clinical cure rates at the end of therapy were 83% (57/69) for bloodstream infections and 84% (22/26) for abdominal infections. Caspofungin did not clear candidiasis in 14 episodes (microbiologic cure rate 75%, 42/56).
  
  
  CONCLUSIONS
  The clinical use of caspofungin has been successful in the treatment of invasive candidiasis, even in patients with prior antifungal exposure. In this unselected review, caspofungin performed similarly as in clinical trials, and clinicians should consider caspofungin as first-line therapy for invasive candidiasis, particularly non-albicans species.
authors.affiliation: Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Aimee K
authors.initials: AK
authors.lastname: Zaas
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Dodds Ashley
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Alexander
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Johnson
authors.forename: John R
authors.initials: JR
authors.lastname: Perfect
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002176:Candida albicans / Q000187:drug effects; D041221:Candida glabrata / Q000187:drug effects; D041022:Candida tropicalis / Q000187:drug effects; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D000077336:Caspofungin; D004334:Drug Administration Schedule; D054714:Echinocandins; D005260:Female; D006801:Humans; D055666:Lipopeptides; D008297:Male; D008499:Medical Records; D009657:North Carolina / Q000453:epidemiology; D010456:Peptides, Cyclic / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D000077336:Caspofungin