title: Persistence of Candida albicans candidemia in non-neutropenic surgical patients: management of a representative patient in the absence of second-line treatment guidelines.
abstract: Primary treatment failure and mortality in non-neutropenic patients with candidemia is high according to clinical trial experience. Current guidelines are mainly useful only for first line treatment strategies.We describe treatment failure and persistent protracted Candida albicans candidemia without clinically evident ocular involvement nor catheter recolonization in a malnourished non-neutropenic surgical patient with peritonitis. Primary antifungal treatment failure with fluconazole and secondary treatment failure with caspofungin occurred in the absence of evident Candida seeding the eye, valvular endocardium, or the intravascular catheter. Switch to liposomal amphotericin B was followed by clinical and microbiological cure. In patients with multiple risk factors for the acquisition of candidemia and life-threatening clinical conditions, the possibility of primary/secondary failure of new potent antifungal regimens may be initially neglected. Additional multicenter controlled clinical data are needed to guide the timing and choice of secondary antifungal treatment regimens in non-neutropenic candidemia patients.
authors.affiliation: Intensive Care Unit, Department of Accident and Emergency, University of Genoa, Genoa, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Pacini
authors.forename: M
authors.initials: M
authors.lastname: Cerana
authors.forename: A
authors.initials: A
authors.lastname: Beltrame
authors.forename: A
authors.initials: A
authors.lastname: Di Biagio
authors.forename: A
authors.initials: A
authors.lastname: De Maria
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D002176:Candida albicans; D000077336:Caspofungin; D004338:Drug Combinations; D054714:Echinocandins; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D016469:Fungemia / Q000188:drug therapy*; D006801:Humans; D007081:Ileostomy; D055666:Lipopeptides; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000627:therapeutic use; D010713:Phosphatidylcholines / Q000627:therapeutic use; D010715:Phosphatidylglycerols / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy*; D017410:Practice Guidelines as Topic
chemical_list: D000935:Antifungal Agents; D004338:Drug Combinations; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D010713:Phosphatidylcholines; D010715:Phosphatidylglycerols; C068538:liposomal amphotericin B; D000666:Amphotericin B; D015725:Fluconazole; D000077336:Caspofungin