Efficacy and safety of caspofungin monotherapy in cancer patients with candidaemia
Abstract number: P1019
Sipsas N.V., Lewis R.E., Raad I.I., Kontoyiannis D.P.
Objective: There is a paucity of data regarding the efficacy and safety of caspofungin (CAS) in cancer patients with candidaemia.
Methods: We retrospectively reviewed the medical records of all adult cancer patients with candidaemia (EORTC criteria) treated with CAS monotherapy for at least 3 consecutive days at MD Anderson Cancer Center (March 2001-February 2007). CAS was given intravenously at 50 mg /day after a 70 mg loading dose. Demographic characteristics, clinical and microbiological data, outcomes, minimal inhibitory concentrations (MIC) of Candida isolates (CLSI method), were recorded.
Results: We identified 65 such patients (20 or 31% had hematological malignancies). The clinical response and mycological response after 7 days of CAS was 80% (51 patients) and 78% respectively. The overall mortality was 5% for day 7, 12% for day 14, and 20% for day 30. The 30-day Candida-attributable mortality was 11%. Bivariate analysis showed that factors significantly associated with crude 30 day mortality were an APACHE II score >20, ICU admission, a positive culture of the tip of the removed central venous catheter, especially when CFU/ml was > 15, persistent fungaemia after initiation of treatment, and the presence of intercurrent bacterial infection. The 30 day attributable mortality in the 12 patients (18%) with fluconazole-resistant or susceptible-dose dependent Candida bloodstream isolates (MIC 8 mg/ml) was 25% vs. 8% in the 53 patients with fluconazole-susceptible Candida (p <0.05). CAS was well tolerated.
Conclusion: Although selection of candidemic cancer patients who received CAS monotherapy might account for the observed favorable outcomes, in our experience CAS had comparable efficacy and safety to the ones described in candidemic patients without malignancy.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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