Cornely Oliver A, Lasso Martin, Betts Robert, Klimko Nickolay, Vazquez Jose, Dobb Geoff, Velez Juan, Williams-Diaz Angela, Lipka Joy, Taylor Arlene, Sable Carole, Kartsonis Nicholas
Klinik I für Innere Medizin, Klinikum der Universität zu Köln, 50924 Köln, Germany.
J Antimicrob Chemother. 2007 Aug;60(2):363-9. doi: 10.1093/jac/dkm169. Epub 2007 May 26.
Caspofungin has demonstrated efficacy in invasive candidiasis. However, in a comparative study, most patients (>83%) had candidaemia. Therefore, we performed a study in patients with non-fungaemic invasive candidiasis.
Adults with proven non-fungaemic invasive candidiasis or probable chronic disseminated candidiasis (CDC) received caspofungin primary or salvage monotherapy. Most patients received 50 mg daily following a 70 mg loading dose. Patients with endocarditis, osteomyelitis or septic arthritis received caspofungin at 100 mg daily and were allowed dose escalation up to 150 mg. Primary efficacy endpoint was the overall response at end of caspofungin therapy. A favourable overall response required complete resolution of symptoms and either eradication of Candida or radiographic resolution.
All 48 patients enrolled had confirmed infection and received>or=1 dose of caspofungin. At study entry, 8% were neutropenic. The mean APACHE II score was 14.3. Most infections were due to Candida albicans (60%) or Candida glabrata (14%). The overall success at end of caspofungin therapy was 81%. Success by site of infection was as follows: peritonitis 77% (10/13), abdominal abscess 89% (8/9), CDC 88% (7/8), osteomyelitis/septic arthritis 100% (4/4), endocarditis 33% (1/3) and multiple sites 75% (6/8). Outcomes were similar across Candida spp. None of the patients had a serious drug-related adverse event or discontinued caspofungin due to toxicity. Overall mortality until 12 week follow-up was 23%.
In deep-seated invasive candidiasis, including peritonitis, abdominal abscesses, CDC and arthritis, caspofungin was effective and safe at regular doses and up to 100 mg daily.
卡泊芬净已在侵袭性念珠菌病中显示出疗效。然而，在一项比较研究中，大多数患者（>83%）患有念珠菌血症。因此，我们对非真菌血症性侵袭性念珠菌病患者进行了一项研究。
确诊为非真菌血症性侵袭性念珠菌病或可能的慢性播散性念珠菌病（CDC）的成人接受卡泊芬净一线或挽救性单药治疗。大多数患者在70mg负荷剂量后每日接受50mg。患有心内膜炎、骨髓炎或化脓性关节炎的患者每日接受100mg卡泊芬净治疗，并允许剂量增加至150mg。主要疗效终点是卡泊芬净治疗结束时的总体反应。良好的总体反应要求症状完全缓解且念珠菌根除或影像学缓解。
所有48例入组患者均确诊感染并接受了≥1剂卡泊芬净。研究开始时，8%的患者为中性粒细胞减少。急性生理与慢性健康状况评分系统（APACHE II）平均评分为14.3。大多数感染由白色念珠菌（60%）或光滑念珠菌（14%）引起。卡泊芬净治疗结束时的总体成功率为81%。按感染部位划分的成功率如下：腹膜炎77%（10/13）、腹腔脓肿89%（8/9）、CDC 88%（7/8）、骨髓炎/化脓性关节炎100%（4/4）、心内膜炎33%（1/3）和多部位75%（6/8）。不同念珠菌属的结果相似。没有患者发生严重的药物相关不良事件或因毒性而停用卡泊芬净。直至12周随访时的总死亡率为23%。
在深部侵袭性念珠菌病中，包括腹膜炎、腹腔脓肿、CDC和关节炎，卡泊芬净常规剂量及每日高达100mg时有效且安全。
