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Caspofungin/voriconazole Lack of efficacy: 2 case reports

In a case series of 5 patients identified to have candidaemia with Candida auris over a period of 6 months from December 2017 to May 2018, 2 men aged 18 years and 22 years were described, who exhibited lack of efficacy during treatment with caspofungin or voriconazole for candidaemia. Case 1: The 18-year-old man was admitted to the emergency unit of trauma center after road traffic accident. On day 2 of admission, he underwent a surgery for degloving injury of right shoulder and axilla junction and transferred to the ICU. He then placed on broad-spectrum antibiotics, central venous catheter (CVC) and mechanical ventilation. Despite this, his condition deteriorated with sepsis and acute renal failure. On day 12 of the admission, his blood culture from both the central and peripheral line grew C. auris. He then treated with caspofungin injection 50mg once daily [route not stated] according to the antifungal susceptibility results. Despite antifungal treatment and high-grade inotropic support, he developed septicaemic shock. On the day 16 of hospitalisation, he succumbed due to infection. Case 3: The 22-year-old man was admitted to the emergency department following a road traffic accident. On examination, he was found to have abdominal injury and bowel perforation. For bowel perforation, he underwent an exploratory laparotomy and end colostomy. Seven days after surgery, he underwent revised surgery due to persistent pus and feculent material from colostomy site. Tracheostomy was performed, central venous catheter (CVC) and Ryle’s tube were placed. On day 2, meropenem injection and cefoperazone/sulbactam was started. One week after the surgery, he developed high-grade fever and leukocytosis. Meanwhile, his blood culture showed the growth of C. auris. He then treated with IV voriconazole injection 200mg, twice a day. Despite antifungal medications for 7 days, he showed persistent candidaemia. Thereafter, chlorhexidine sponging was done three times a week and blood culture repeated, which became sterile. Later, he developed acute liver injury with hyperbilirubinaemia. After a hospital stay for 58 days, he died due to sepsis. Bajpai V, et al. Multidrug-Resistant Candida auris Fungemia in Critical Care Units: Experience from a Tertiary Care Hospital in India. Microbial Drug Resistance Mechanisms, Epidemiology and Disease 26: 145-149, No. 2, Feb 2020. Available from: URL: http://doi.org/10.1089/mdr.2019.0021

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Reactions 12 Dec 2020 No. 1834