Limitations of caspofungin in the treatment of obstructive pyonephrosis due to <it>Candida glabrata </it>infection

• Main Authors: Ross Calum N, Schelenz Silke
• Format: Article
• Language: English
• Published: BMC 2006-08-01
• Series: BMC Infectious Diseases
• Online Access: http://www.biomedcentral.com/1471-2334/6/126

<p>Abstract</p> <p>Background</p> <p>Caspofungin is a new antifungal agent with high-level activity against a number of <it>Candida </it>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 <it>Candida </it>species such as pyonephrosis.</p> <p>Case presentation</p> <p>We report a case of obstructive pyonephrosis due to an azole (fluconazole and itraconazole) resistant <it>Candida glabrata </it>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.</p> <p>Conclusion</p> <p>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 <it>Candida </it>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 <it>Candida </it>urinary tract infection is reviewed.</p>