Objective Characteristics of non-Candida albicans sepsis or invasive fungal infection and effectiveness of caspofungin in paediatric intensive care unit (PICU) patients.
Methods Four PICU patients (3% of total) with confirmed non-C albicans haematogenous sepsis (n = 3) or invasive pulmonary infection (n = 1) were treated with caspofungin as a first line (n = 1) or rescue treatment (n = 3) in breakthrough candidaemia previously treated with liposomal amphotericin B and fluconazole. Patients had chronic disease (4), central vascular lines (4), urinary catheters (4), peritoneal catheter (1), tracheostomy (3), gastrostomy (1) and had received multiple antibiotic courses (4). Length of PICU stay was 25–137 days and mechanical ventilation 11–137 days.
Results Blood cultures grew Candida tropicalis, famata, krusei, lusitaniae. The same strains as well as Candida incospicua were isolated in central line catheter, bronchoalveolar lavage (BAL), urine, gatrostomy, pharyngeal and skin cultures (3). Candida parapsilosis had grown in BAL (1). Patients were receiving liposomal amphotericin B and fluconazole (3), inotropes (1) and had persistent fever >39°C, raised C-reactive protein, increased or decreased white blood cells and negative procalcitonin (3). Positive procalcitonin (1) was attributed to a mixed infection (C krusei and Pseudomonas aeruginosa). Caspofungin was well tolerated without any adverse effects. Decline of infection indices and clinical improvement was reported after 4 days of administration. All patients were discharged home in good clinical condition.
Conclusions Invasive non-C albicans fungal infections in high-risk pediatric patients are commonly manifested as sepsis and breakthrough candidaemia with negative procalcitonin. Caspofungin is a well-tolerated alternative effective treatment as a first-line or rescue treatment.