[Tolerance of caspofungin in intensive care unit: a prospective study].
OBJECTIVE
Caspofungin has shown efficacy and very low toxicity in empirical antifungal therapy in refractory invasive Aspergillus infections and invasive candidiasis in neutropenic (or non) patients. To date, there is no data on tolerability of caspofungin in ICU patients. The aim of this study was to evaluate caspofungine tolerability in critical care patients.


METHODS
Over a 36-month period, 1430 patients were admitted in a general intensive care unit. All patients data were collected in a prospective database. All the clinical or biological side effects reported in the multicentric studies were required. The patients were laminated in two groups, according to the initial hepatic function.


RESULTS
Seventy-three patients were treated with caspofungin (5.1%) and 58% were immunocompromised. Immunosuppression was due to acute leukemia (30%), solid organ transplant (20%) or other causes of immunosuppression. In this group, SAPS2 was higher (51+/-20 versus 44+/-20; p<0.05) as mortality rate was (60% versus 23%). More than 90% of patients were ventilated and 55% needed extrarenal therapy. Caspofungin treatment was initiated for aspergillosis in 12 patients, candidiasis in 33 patients and others indications. Partial or complete response to treatment was 72%. Median duration of caspofungin administration was 11 days, no liver dysfunction or acute renal failure due to caspofungin was reported whatever initial liver function was.


CONCLUSIONS
This prospective open study demonstrate the very low toxicity of caspofungin even in critical care patients.
Pôle anesthésie-réanimation, service de réanimation adulte, hôpital Hôtel-Dieu, CHU de Clermont-Ferrand, boulevard Léon-Malfreyt, 63058 Clermont-Ferrand, France. jmconstantin@chu-clermontferrand.fr
J-M
JM
Constantin
L
L
Roszyk
R
R
Guerin
F
F
Bannier
C
C
Chartier
S
S
Perbet
E
E
Futier
S
S
Cayot-Constantin
V
V
Sapin
J-E
JE
Bazin
D000328:Adult; D000368:Aged; D000740:Anemia / Q000139:chemically induced* / Q000453:epidemiology; D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000077336:Caspofungin; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology*; D003422:Critical Care; D003875:Drug Eruptions / Q000453:epidemiology / Q000209:etiology; D054714:Echinocandins / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000453:epidemiology; D006402:Hematologic Diseases / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy*; D010146:Pain / Q000139:chemically induced / Q000453:epidemiology; D011183:Postoperative Complications / Q000188:drug therapy; D011446:Prospective Studies
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin
Tolérance de la caspofongine chez les patients de réanimation: étude prospective.