Dataset Information

Successful therapy of Candida pulcherrima fungemia in a premature newborn with liposomal amphotericin B and micafungin.

ABSTRACT: New Candida species may cause bloodstream infections challenging current therapeutic approaches because of unpredictable susceptibility and virulence. In the present report, we describe a fungemia case due to Candida pulcherrima in a premature neonate. After full in vitro diagnostic workup, the neonate was successfully treated with liposomal amphotericin B and micafungin achieving rapid fungal eradication from blood.

SUBMITTER: Mpakosi A

PROVIDER: S-EPMC5018202 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

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Successful therapy of Candida pulcherrima fungemia in a premature newborn with liposomal amphotericin B and micafungin.

Mpakosi Alexandra A Siopi Maria M Falaina Vasiliki V Siafakas Nikolaos N Roilides Emmanuel E Kimouli Maria M Theodoraki Martha M Karle Paraskevi P Meletiadis Joseph J

Medical mycology case reports 20160601

New Candida species may cause bloodstream infections challenging current therapeutic approaches because of unpredictable susceptibility and virulence. In the present report, we describe a fungemia case due to Candida pulcherrima in a premature neonate. After full in vitro diagnostic workup, the neonate was successfully treated with liposomal amphotericin B and micafungin achieving rapid fungal eradication from blood. ...[more]

PMID: 27642562

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Project description:Invasive candidiasis and candidemia are life-threatening nosocomial infections in intensive care patients.A post hoc analysis of a phase 3 trial assessing micafungin (100 mg/day for subjects > 40 kg; 2 mg/kg/day for subjects <or= 40 kg) versus liposomal amphotericin B (3 mg/kg/day). Subgroups were defined according to the type of ward on the first day of treatment: intensive care unit (ICU) or non-ICU. Multivariate regression was performed to identify factors associated with treatment success at end of therapy and all-cause mortality at days 8 and 30.In non-ICU subjects, treatment success was significantly higher for micafungin versus liposomal amphotericin B (85% (n = 108/127) versus 72.1% (n = 98/136); P = 0.0113). However, for ICU subjects, treatment success rates for micafungin versus liposomal amphotericin B were similar (62.5% (n = 75/120) versus 66.4% (n = 73/110); P = 0.5828). Overall, treatment success was significantly lower in ICU subjects compared with non-ICU subjects (64.3% (n = 148/230) versus 78.3% (n = 206/263); P = 0.0006). Multivariate regression analysis revealed a lower likelihood of treatment success for: ICU versus non-ICU subjects; persistent neutropenia; and high versus low Acute Physiology and Chronic Health Evaluation (APACHE) II scores. However, when interactions between potential explanatory factors were included in the analysis model, ICU status no longer emerged as a significant associated variable but the association between APACHE II score and treatment outcome remained. Further analyses indicated that the likelihood of mortality at day 8 and day 30 was lower for subjects with lower APACHE II scores. Renal function was significantly better in micafungin versus liposomal amphotericin B subjects: a difference (liposomal amphotericin B - micafungin in mean peak change in estimated glomerular filtration rate (ml/minute/1.73 m2) of -18.2 (P < 0.0001) and -17.7 (P = 0.0124) in non-ICU and ICU subjects, respectively.Overall, ICU subjects had lower treatment success rates than non-ICU subjects for both liposomal amphotericin B and micafungin. Multivariate regression after controlling for potential confounding factors suggested the APACHE II score remained a potential explanatory factor associated with treatment success, mortality at day 8, and mortality at day 30.Post hoc analysis--clinicaltrials.gov trial NCT00106288.

Dataset Information

Successful therapy of Candida pulcherrima fungemia in a premature newborn with liposomal amphotericin B and micafungin.

Publications

Successful therapy of Candida pulcherrima fungemia in a premature newborn with liposomal amphotericin B and micafungin.

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