Treatment with Micafungin in a Preterm Neonate with an Invasive Candida parapsilosis Infection after a Severe Terlipressin-Induced Skin Necrosis.

Domenico Umberto De Rose,Fiammetta Piersigilli,Olivier Danhaive,Bianca Maria Goffredo,Cinzia Auriti,Andrea Dotta

doi:10.3390/pathogens10070890

Abstract

Candida parapsilosis infections are increasingly reported in preterm neonates, but the optimal treatment remains uncertain. We report the clinical history of an extremely preterm neonate, who developed a devastating skin necrosis due to terlipressin administration, with subsequent superinfection by Candida parapsilosis. The infant underwent multiple curettages and skin grafts to resolve skin lesions and was treated with systemic micafungin administration at a high dose (8 mg/kg/day), with resolution of the fungal infection.

Highlights

Candida parapsilosis infections are increasingly reported in preterm neonates, but the optimal treatment remains uncertain
Invasive Candida infections (ICIs) are a major cause of morbidity and mortality among very preterm infants [1]; Candida albicans is the most frequently occurring species [2], Candida parapsilosis infections are increasingly reported in preterm neonates [3]
Despite the high minimum inhibitory concentration (MIC) necessary for Candida parapsilosis eradication, echinocandins have a prominent role when an ICI occurs in very preterm infants

Summary

Case Description

An extremely preterm neonate (gestational age, 24 weeks; body weight, 500 g) was born by vaginal delivery in a 2nd level hospital. Blood cultures resulted micafungin (MIC, 0.5 μg/mL), anidulafungin (MIC, 2 μg/mL), fluconazole (MIC, 0.5 μg/mL), itranegative, but the child had been on antimicrobial therapy for several days. Among the effective monitored and tomicafungin the participation in clinical and publications, micafungin was administered gals, we chose because of trials the feasibility of plasma concentration monitoring intravenously at a dose of 8 mg/kg/day; it was diluted in 0.9% saline solution at a concentration of via heel stick capillary samples [8]. 2 mg/mL and infused intravenously through epicutaneo-cava catheter in one hour Plasma micaparents, both in relation the high of micafungin to be administered and monitored fungin concentrations were to measured bydosage high performance liquid chromatography (HPLC). Plasma micafungin concentrations were measured by high performance liquid chromatography (HPLC) on the third day of the starting of therapy.

Findings

Discussion

Conclusions