Combined therapy with liposomal amphotericin B and caspofungin for intravenous catheter (CVC) related candidemia in extremely low birth weight (ELBW) neonates

Castagnola, E., Natalizia, A.R., Franceschi, A., Mantero, E., Tuo, P.

Author address: 

G.Gaslini Children Hospital, GENOA, Italy

Abstract: 

Candidemia represent an important complication in ELBW neonates, with a high risk of secondary localizations in presence of persistently positive blood cultures. Catheter removal is mandatory for its treatment, but sometime catheter withdrawal may be impossible or at least very difficult in patients in life-threatening clinical condition or with limited vascular sites, like ELBW neonates. We used the association of liposomal amphotericin B and caspofungin in 2 ELBW neonates when CVC removal was not possible. Case 1: born at 23 weeks of gestational age, weight 0.71 kg. Candida parapsilosis was isolated from blood cultures at 19 days of life. Liposomal amphotericin B 3 mg/kg/day was promptly administered, but blood cultures persisted positives, in spite of many CVC substitution, and general clinical conditions did not improve. A slight asimmetry of lateral ventricula was present at cerebral ultrasound, without signs of intracerebral hemorrhage. After 30 days and multiple CVC changes, caspofungin at 50 mg/m2 was added. At this time clinical conditions started to improve, but blood cultures persisted positive. After 20 days of treatment association the CVC could be removed and blood cultures resulted negative. No further change in cerebral ultrasound was observed. Case 2: born at 24 weeks of gestational age, weight 0.7 kg. Candida glabrata was isolated from blood cultures at 13 days of life. Liposomal amphotericin B 3 mg/kg/day was promptly administered. Caspofungin at 50 mg/m2 was added after 4 days because of worsening clinical condition and persistently positive blood cultures in spite of repeated CVC changes. After this change blood cultures remained positive but clinical condition sharply improved. Combined therapy was continued for 23 days, when CVC could be changed. At this point blood cultures became negatives. Treatment was continued for other 7 days and then discontinued. In both cases the treatment was well tolerated and no clinical or radiological signs of secondary localization were observed during the treatment period and after other 30 days from discontinuation of antifungals. The association of liposomal amphotericin B and caspofungin may represent a tolerate and effective option for neonatal candidemia when CVC removal is not effective and/or feasible.
2007

abstract No: 

P220

Full conference title: 

3rd Trends in Medical Mycology
    • TIMM 3rd (2011)