title: Caspofungin irrigation through percutaneous calicostomy catheter combined with oral flucytosine to treat fluconazole-resistant symptomatic candiduria.
abstract: Candiduria may be a marker of serious fungal infections such as pyelonephritis. With the exception of fluconazole and flucytosine, antifungals drugs are not excreted into the urine as active drugs, making the management of infection due to fluconazole-resistant Candida difficult. We report a case of recurrent Candida parapsilosis candiduria in a kidney transplant recipient suffering from chronic ureteral obstruction requiring permanent ureteral catheterization (double-J stent). Attempts to remove the stent led to pyelonephritis episodes during which only Candida was isolated from the urine. Following several courses of azole-based therapy, the causative agent became resistant to fluconazole. Clinical and mycological cure were obtained combining irrigations of caspofungin through a percutaneous calicostomy catheter and oral flucytosine. This strategy may represent an interesting therapeutic alternative in case of fluconazole-resistant symptomatic candiduria.
authors: Service de néphrologie et transplantation rénale, hôpitaux universitaires de l'Est-Parisien, hôpital St-Antoine, 184, rue du Faubourg St-Antoine, 75012 Paris, France.
authors: H
authors: H
authors: Garcia
authors: Service de parasitologie-mycologie, hôpitaux universitaires de l'Est-Parisien, hôpital St-Antoine, 184, rue du Faubourg St-Antoine, 75012 Paris, France.
authors: J
authors: J
authors: Guitard
authors: Service de néphrologie et transplantation rénale, hôpitaux universitaires de l'Est-Parisien, hôpital St-Antoine, 184, rue du Faubourg St-Antoine, 75012 Paris, France.
authors: J
authors: J
authors: Peltier
authors: Service d'urologie, hôpitaux universitaires de l'Est-Parisien, hôpital St-Antoine, 184, rue du Faubourg St-Antoine, 75012 Paris, France.
authors: M
authors: M
authors: Tligui
authors: Service d'urologie, hôpitaux universitaires de l'Est-Parisien, hôpital St-Antoine, 184, rue du Faubourg St-Antoine, 75012 Paris, France.
authors: S
authors: S
authors: Benbouzid
authors: Service de néphrologie et transplantation rénale, hôpitaux universitaires de l'Est-Parisien, hôpital St-Antoine, 184, rue du Faubourg St-Antoine, 75012 Paris, France.
authors: S Ait
authors: SA
authors: Elhaj
authors: Service de néphrologie et transplantation rénale, hôpitaux universitaires de l'Est-Parisien, hôpital St-Antoine, 184, rue du Faubourg St-Antoine, 75012 Paris, France.
authors: E
authors: E
authors: Rondeau
authors: Service de parasitologie-mycologie, hôpitaux universitaires de l'Est-Parisien, hôpital St-Antoine, 184, rue du Faubourg St-Antoine, 75012 Paris, France. Electronic address: christophe.hennequin@upmc.fr.
authors: C
authors: C
authors: Hennequin
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D058365:Candidiasis, Invasive / Q000628:therapy* / Q000652:urine; D000077336:Caspofungin; D003131:Combined Modality Therapy; D025141:Drug Resistance, Fungal; D054714:Echinocandins / Q000008:administration & dosage*; D015725:Fluconazole / Q000627:therapeutic use; D005437:Flucytosine / Q000008:administration & dosage*; D006801:Humans; D007670:Kidney Calices / Q000473:pathology / Q000601:surgery*; D055666:Lipopeptides; D008297:Male; D007507:Therapeutic Irrigation / Q000379:methods; D014546:Urinary Catheterization / Q000379:methods; D014552:Urinary Tract Infections / Q000628:therapy*
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D015725:Fluconazole; D005437:Flucytosine; D000077336:Caspofungin
keywords: Azole resistance; Candida; Candiduria; Candidurie; Caspofungin; Caspofungine; Irrigation locale; Local irrigation; Resistance aux azolés