Successful therapy of Candida pulcherrima fungemia in a premature newborn with liposomal amphotericin B and micafungin

Mpakosi, Alexandra; Siopi, Maria; Falaina, Vasiliki; Siafakas, Nikolaos; Roilides, Emmanuel; Kimouli, Maria; Theodoraki, Martha; Karle, Paraskevi; Meletiadis, Joseph

doi:10.1016/j.mmcr.2016.08.002

Cited by 4 publications

(2 citation statements)

References 25 publications

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“…Liposomal amphotericin B is also recommended, not as a first line, with similar efficacy as micafungin. A successful outcome was observed with liposomal amphotericin B plus micafungin in a pre-term infant with C. pulcherrima fungemia and in an oncology patient suffering C. guillermondii infection [ 35 , 36 ]. Favorable results were reported for C. krusei fungemia treated with amphotericin B plus caspofungin [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Role of Antifungal Combinations in Difficult to Treat Candida Infections

Vitale

2021

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Candida infections are varied and, depending on the immune status of the patient, a life-threatening form may develop. C. albicans is the most prevalent species isolated, however, a significant shift towards other Candida species has been noted. Monotherapy is frequently indicated, but the patient’s evolution is not always favorable. Drug combinations are a suitable option in specific situations. The aim of this review is to address this problem and to discuss the role of drug combinations in difficult to treat Candida infections. A search for eligible studies in PubMed and Google Scholar databases was performed. An analysis of the data was carried out to define in which cases a combination therapy is the most appropriate. Combination therapy may be used for refractory candidiasis, endocarditis, meningitis, eye infections and osteomyelitis, among others. The role of the drug combination would be to increase efficacy, reduce toxicity and improve the prognosis of the patient in infections that are difficult to treat. More clinical studies and reporting of cases in which drug combinations are used are needed in order to have more data that support the use of this therapeutic strategy.

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Section: Discussionmentioning

confidence: 99%

Role of Antifungal Combinations in Difficult to Treat Candida Infections

Vitale

2021

JoF

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“…Clinical evidence regarding the combination of amphotericin B with echinocandins for invasive candidiasis is scarce and mostly published as case reports. Mpakosi et al reported the successful treatment with liposomal amphotericin B and micafungin of a preterm infant with Candida (Metschnikowia) pulcherrima fungaemia [ 36 ]. This rare species is, along with C. auris , part of the Metschnikowiaceae family.…”

Section: Discussionmentioning

confidence: 99%

In Vitro Interaction and Killing-Kinetics of Amphotericin B Combined with Anidulafungin or Caspofungin against Candida auris

et al. 2021

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Treatment of invasive infections caused by Candida auris is challenging due to the limited therapeutic options. The combination of antifungal drugs may be an interesting and feasible approach to be investigated. The aim of this study was to examine the in vitro activity of amphotericin B in combination with anidulafungin or caspofungin against C. auris. In vitro static time–kill curve experiments were conducted for 48 h with different combinations of amphotericin B with anidulafungin or caspofungin against six blood isolates of C. auris. The antifungal activity of 0.5 mg/L of amphotericin B was limited against the six isolates of C. auris. Similarly, echinocandins alone had a negligible effect, even at the highest tested concentrations. By contrast, 1 mg/L of amphotericin B showed fungistatic activity. Synergy was rapidly achieved (8 h) with 0.5 mg/L of amphotericin B plus 2 mg/L of anidulafungin or caspofungin. These combinations lead to a sustained fungistatic effect, and the fungicidal endpoint was reached against some C. auris isolates. Additionally, ≥0.5 mg/L of either of the two echinocandins with 1 mg/L of amphotericin B resulted in fungicidal effect against all C. auris isolates. In conclusion, combinations of amphotericin B with anidulafungin or caspofungin provided greater killing with a lower dose requirement for amphotericin B compared to monotherapy, with synergistic and/or fungicidal outcomes.

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Elevated minimum inhibitory concentrations to antifungal drugs prevail in 14 rare species of candidemia-causing Saccharomycotina yeasts

et al. 2020

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Antifungal susceptibility profiles of rare Saccharomycotina yeasts remain missing, even though an increase in prevalence of such rare Candida species was reported in candidemia. Majority of these rare yeast species carry intrinsic resistances against at least one antifungal compound. Some species are known to be cross-resistant (against multiple drugs of the same drug class) or even multi-drug resistant (against multiple drugs of different drug classes). We performed antifungal susceptibility testing (AFST) according to EUCAST broth microdilution for 14 rare species (Clavispora lusitaniae, Candida intermedia, Candida auris, Diutina rugosa, Wickerhamiella pararugosa, Yarrowia lipolytica, Pichia norvegensis, Candida nivariensis, Kluyveromyces marxianus, Wickerhamomyces anomalus, Candida palmioleophila, Meyerozyma guilliermondii, Meyerozyma caribbica, and Debaryomyces hansenii) known to cause candidemia. In total, 234 isolates were tested for amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, anidulafungin, micafungin, and caspofungin. Amphothericin B had the broadest efficiency against the 14 tested rare yeast species, while high minimum inhibitory concentrations (MICs) against azole drugs and echinocandins were common. Voriconazole was the most efficient azole drug. Multidrug resistance was observed for the species C. auris and K. marxianus. Multidrug resistant individual isolates were found for Y. lipolytica and M. caribbica. In conclusion, the observed high MIC values of the rare Saccharomycotina species tested limit antifungal treatment options, complicating the management of such infections.

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Successful therapy of Candida pulcherrima fungemia in a premature newborn with liposomal amphotericin B and micafungin

Cited by 4 publications

References 25 publications

Role of Antifungal Combinations in Difficult to Treat Candida Infections

Role of Antifungal Combinations in Difficult to Treat Candida Infections

In Vitro Interaction and Killing-Kinetics of Amphotericin B Combined with Anidulafungin or Caspofungin against Candida auris

Elevated minimum inhibitory concentrations to antifungal drugs prevail in 14 rare species of candidemia-causing Saccharomycotina yeasts

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