Successful fluconazole combined with caspofungin treatment of candida bloodstream infection in preterm infant A case report

Abstract

Rationale: Candida bloodstream infection continues to be a significant cause of mortality in premature infants. Amphotericin B has been recommended as the primary treatment; however, its use is limited due to drug-induced nephrotoxicity and amphotericin B-resistant candidemia. Patient concerns: The gestational age was 29 (+6) weeks, and birth weight was 1760 g. Diagnosis: The infant was diagnosed with Candida parapsilosis bloodstream infection. Interventions: Fluconazole, 12 mg/kg/day, combined with caspofungin (loading dose 3 mg/kg, at a maintenance dose of 2 mg/kg every 24 h) therapy was administered to premature infant with Candida bloodstream infection. When fluconazole or caspofungin was used to treat Candida bloodstream infection in preterm infants, the blood cultures of the infant remained positive for Candida parapsilosis. Outcomes: All persistent candidemia resolved on fluconazole combined with caspofungin therapy. There were no adverse effects, hepatotoxicity, nephrotoxicity, anemia, or thrombocytopenia. Lessons: Fluconazole combined with caspofungin successfully treated Candida bloodstream infection in premature infants at 29 + 6 weeks’ gestational age, but large-scale clinical trials are required.