905. Evaluating Caspofungin Utilization, Indication, and Outcomes of Pediatric Patients Treated for Candidemia 
Session: Poster Abstract Session: Antimicrobial Utilization and Resistance in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • 905_NatalieNeu_small.pdf (2.3 MB)
  • Background: 

    The purpose of this study is to describe Caspofungin (CAS) utilization in pediatric candidemia, the indications for CAS use, and patient outcomes.

    Methods:  

    We reviewed pediatric cases of candidemia treated with CAS from 2002 to 2008 and assessed prior antifungal (AF) use, indication for CAS use, and clinical or lab-related adverse drug events (ADEs) that occurred during CAS treatment.  An outcome was considered “favorable” if a priori clinical and microbiologic criteria were fulfilled.

    Results:  

    Thirty-five cases of candidemia were treated with CAS and occurred in 26 patients (median age 7 yrs, range: 3 mos – 18 yrs). Underlying conditions included gastrointestinal disorders (n=20), cancer (n=6), congenital heart disease (n=2), and other (n=7).  C.glabrata was the most common species (29%); C. albicans, C. parapsilosis, and C. tropicalis each caused 23% of infections.  Eighty-nine % of cases received prior AF therapy of which 83% was amphotericin (AmB) and/or fluconazole (FLU). Prior AF therapy included treatment or prophylaxis in 77% and 23% of cases, respectively. The most common indications for CAS use were perceived clinical failure and/or ADEs from other AF agents (74% of cases). In 57% of cases, CAS was used concomitantly with other AFs: AmB (31%), FLU (23%), and voriconazole (3%).Seventy-seven % of cases met criteria for a favorable outcome. Among the 8 cases without a favorable outcome, 3 relapsed with candidemia within 28 days, 2 died of an underlying condition, 1 each had worsening disseminated disease, persistently positive peritoneal cultures, or perceived clinical failure. All unfavorable responses occurred with non-C. albicans species. ADEs were associated with CAS treatment in 16 cases (46%) of which 13 had ≥ 1 abnormal laboratory finding: hypokalemia (n=6), transaminitis (n=4), elevated bilirubin (n=4), and/ or elevated creatinine (n=1). None had CAS discontinued.

    Conclusion: 

    In our children’s hospital, CAS was most often used to treat candidemia after perceived clinical failure with previous AF therapy.  Fifty-seven % of cases received CAS with other AF agents and 77% had favorable outcomes. Use of CAS in pediatric patients with candidemia should be evaluated in multicenter studies and compared to current guidelines.


    Subject Category: P. Pediatric and perinatal infections

    Ryan Close, BA1, Natalie Neu, MD, MPH2, Christine J. Kubin, PharmD3 and Lisa Saiman, MD, MPH2,4, (1)College of Physicians and Surgeons, Columbia University, New York, NY, (2)Department of Pediatrics, Columbia University Medical Center, New York, NY, (3)Department of Medicine and Pharmacy, Columbia University; NewYork-Presbyterian Hospital, New York, NY, (4)Department of Epidemiology, New York-Presbyterian Hospital, New York, NY

    Disclosures:

    R. Close, None

    N. Neu, Merck Pharmaceuticals: Grant Investigator and I recieved an investigator award from Merck, Research grant

    C. J. Kubin, None

    L. Saiman, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.