CASPOFUNGIN (CSP): WHAT MEASURES RESISTANCE?

Hernandez S, Najvar L, Lopez-Ribot J, McCarthy D, Bocanegra R, Graybill JR

Author address: 

UT Health Sciences Center, San Antonio, United States

Abstract: 

BACKGROUND: There are no clear in vitro standards which predict clinical response to CSP. Resistant isolates are few and tend to be laboratory mutants which are avirulent in mice. We present a patient with rising MIC to CSP and clinical failure. We evaluated 3 sequential isolates of C. albicans in mice to determine whether this model could predict in vivo failure. METHODS: A patient with HIV associated C. albicans esophagitis sequentially failed multiple antifungals, including fluconazole (FLU) and other triazoles. He then responded to 4 weeks with CSP at 50 mg/day. Later he relapsed, and then failed second course of CSP. Isolate 1 was pre-CSP; isolate 2 followed a successful 4 week CSP treatment; isolate 3 was post CSP failure. MIC values were done by NCCLS M27-A methods. Groups of 8-10 mice were infected intravenously with C. albicans and treated with water (controls) PO, FLU at 5 mg/kg PO BID or increasing doses of CSP intraperitoneally. Mann Whitney test was used to compare kidney counts. *=p
2003

abstract No: 

none

Full conference title: 

13th Annual Focus on Fungal Infections
    • FFI 13th (2003)