Development of candidemia on caspofungin therapy: a case report.
Caspofungin, an echinocandin, is approved for use in invasive candidiasis. Few cases of break-through candidal infections during caspofungin therapy have been reported and none have involved Candida parapsilosis. Here, we report a patient who developed multiple post-operative complications after pancreaticoduodenectomy for a pancreatic mass, including fungemia due to C. parapsilosis, while on caspofungin for treatment of Candida glabrata peritonitis. The fungemia resolved after a central venous catheter was removed and therapy was switched from caspofungin to amphotericin B lipid complex. Studies of C. parapsilosis susceptibility and the pharmacodynamics and drug interactions of caspofungin that may contribute to breakthrough fungemia are discussed.
Cheung
C
C
Dept. of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY, USA.
Guo
Y
Y
Gialanella
P
P
Feldmesser
M
M
D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000627:therapeutic use*; D041221:Candida glabrata / Q000187:drug effects; D002177:Candidiasis / Q000097:blood* / Q000188:drug therapy; D000077336:Caspofungin; D002408:Catheters, Indwelling / Q000382:microbiology; D003428:Cross Infection / Q000097:blood / Q000188:drug therapy / Q000517:prevention & control; D004338:Drug Combinations; D025141:Drug Resistance, Fungal; D054714:Echinocandins; D016469:Fungemia / Q000188:drug therapy*; D006801:Humans; D055666:Lipopeptides; D008297:Male; D016577:Pancreaticoduodenectomy; D010456:Peptides, Cyclic / Q000627:therapeutic use*; D010713:Phosphatidylcholines / Q000627:therapeutic use*; D010715:Phosphatidylglycerols / Q000627:therapeutic use*; D011183:Postoperative Complications
D000935:Antifungal Agents; D004338:Drug Combinations; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D010713:Phosphatidylcholines; D010715:Phosphatidylglycerols; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000077336:Caspofungin