Schelenz Silke, Ross Calum N
Microbiology Department, Norfolk and Norwich University Hospital, UK.
BMC Infect Dis. 2006 Aug 8;6:126. doi: 10.1186/1471-2334-6-126.
Caspofungin is a new antifungal agent with high-level activity against a number of Candida species including those that are resistant to azoles. Its good safety profile and low nephrotoxicity makes it an attractive drug to treat fungal infections in patients with compromised renal function. However, little is known about the clinical efficacy in the treatment of complicated urinary tract infections due to Candida species such as pyonephrosis.
We report a case of obstructive pyonephrosis due to an azole (fluconazole and itraconazole) resistant Candida glabrata strain that failed to respond to intravenous treatment with caspofungin. A sustained clinical and microbiological response was only achieved after percutaneous drainage and instillation of amphotericin B deoxycholate into the renal pelvis in combination with intravenous liposomal amphotericin B.
This case demonstrates the limitation of intravenous antifungal agents such as caspofungin as the sole treatment of an obstructive upper urinary tract infection due to Candida species. In order to achieve long term sustained cure from an obstructive pyonephrosis, pus and fungal balls should be drained and an anti-fungal agent such as amphotericin B deoxycholate instilled locally. The pharmacokinetics and role of caspofungin in the treatment of complicated Candida urinary tract infection is reviewed.
卡泊芬净是一种新型抗真菌药物，对多种念珠菌具有高效活性，包括对唑类耐药的念珠菌。其良好的安全性和低肾毒性使其成为治疗肾功能受损患者真菌感染的有吸引力的药物。然而，对于卡泊芬净治疗由念珠菌引起的复杂性尿路感染（如肾积脓）的临床疗效知之甚少。
我们报告一例由对唑类（氟康唑和伊曲康唑）耐药的光滑念珠菌菌株引起的梗阻性肾积脓病例，该病例对卡泊芬净静脉治疗无反应。仅在经皮引流并向肾盂内注入两性霉素B脱氧胆酸盐联合静脉注射脂质体两性霉素B后才实现持续的临床和微生物学反应。
本病例证明了静脉用抗真菌药物如卡泊芬净作为念珠菌引起的梗阻性上尿路感染的单一治疗方法的局限性。为了从梗阻性肾积脓中实现长期持续治愈，应引流脓液和真菌球，并局部注入抗真菌药物如两性霉素B脱氧胆酸盐。本文综述了卡泊芬净在治疗复杂性念珠菌尿路感染中的药代动力学和作用。
