Preterm neonates in NICU treated with Caspofungin: Our experience

Abstract

Invasive Candida spp infections (ICI) are an increasing problem in NICUs. New antifungal drugs are guaranteed to better manage neonatal ICI. We describe a case series of preterm neonates treated with Caspofungin (CSP) in our NICU. In the years 2005 through 2009, 15 VLBW (24–32 W, 600–1460 g) and 1 term neonate (41 W, 2680 g) with documented Candida ICI were resistant to the conventional antifungal treatments. Candida spp isolates were Albicans (7 cases), Krusei (6), and Parapsilosis (2). In two cases, an organ localization was also detected. In all infants, we decided to add to treatment also CSP on a compassionate, off-label basis in a single i.v.1-hour infusion daily dose; dosages: 25 mg/m2 (11 cases) and 50 mg/m2 (4 cases) for 19 mean day-courses. Clinical, laboratory, microbiological monitoring was performed according to a detailed unit protocol. In particular, CBC, liver enzyme values and ultrasonography scans of the various body organs were performed every 2 to 6 days. Infants were then addressed to a 2-year follow-up after discharge. No adverse reactions or intolerances putatively attributable to CSP were documented. Mean serum ALT,AST,LDH,CPK,CKMB,BUN and creatinine values were always in the normal range. Mean serum values of γ–GT were 185 ± 78 U/L (1°day) and 195 ± 97 (21°days) in 8 cases. Transient mild hypokaliemia occurred in 4 cases; hypoalbuminemia in 2; thrombocytopenia in 1 case. Four infants died: 1 severe IVH and 3 due to ICI (CSP 25 mg/m2 dosage). In our experience, CSP used at a dosage of 50 mg/m2 daily, for courses of 15–21 mean days was effective and well tolerated in the management of resistant ICI with persistent candidemias in preterm VLBW infants in NICU.