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Candida parapsilosis complex, caspofungin, children
Background: We aimed to evaluate the correlation of caspofungin E-tests with the prognosis and response to caspofungin therapy of Candida parapsilosis complex bloodstream infections in children hospitalized in pediatric intensive care unit.
Methods: All children who had C.parapsilosis complex bloodstream infections and who were treated with caspofungin were included in this retrospective study. For each patient, the following parameters, including all consecutive blood and central venous catheter (CVC) cultures, duration between diagnosis and CVC removal, mortality rate, relapses of the C.parapsilosis complex infections as well as the demographic features, were recorded.
Results: The study covered 53 patients with a median age of 11 months. The median duration of C.parapsilosis complex isolation was 31 days. The CVC rescue rate was 33.3% under caspofungin treatment. In 92.4% of the patients, the negative culture was achieved within a median duration of 14 days. The rate of relapses was 18.9%. The overall mortality rate was %37.7 (20 patients) and 30-days mortality rate was 7.5% (4 patients).
Conclusions: Caspofungin is an attractive option due to its effects on biofilms in vivo, while the reflection of its affect on C.parapsilosis complex was limited in our study, but it should not be underestimated in children who strongly need the presence of central venous catheters. Moreover, in vivo susceptibility might not always guarantee good clinical response in clinical practice. The clinicians should weigh their priority for their patients and choose the optimal antifungal therapy for C.parapsilosis complex infections in children.
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