Caspofungin irrigation through percutaneous calicostomy catheter combined with oral flucytosine to treat fluconazole-resistant symptomatic candiduria.

Abstract

Candiduria may be a marker of serious fungal infections such as pyelonephritis. With the exception of fluconazole and flucytosine, antifungals drugs are not excreted into the urine as active drugs, making the management of infection due to fluconazole-resistant Candida difficult. We report a case of recurrent Candida parapsilosis candiduria in a kidney transplant recipient suffering from chronic ureteral obstruction requiring permanent ureteral catheterization (double-J stent). Attempts to remove the stent led to pyelonephritis episodes during which only Candida was isolated from the urine. Following several courses of azole-based therapy, the causative agent became resistant to fluconazole. Clinical and mycological cure were obtained combining irrigations of caspofungin through a percutaneous calicostomy catheter and oral flucytosine. This strategy may represent an interesting therapeutic alternative in case of fluconazole-resistant symptomatic candiduria.

• Authors: H Garcia, J Guitard, J Peltier, M Tligui, S Benbouzid, S Ait Elhaj, E Rondeau, C Hennequin
• Journal: Journal de mycologie medicale (J Mycol Med) Vol. 25 Issue 1 Pg. 87-90 (Mar 2015) ISSN: 1773-0449 [Electronic] France
• PMID: 25649231 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2015. Published by Elsevier Masson SAS.

Chemical References

• Antifungal Agents
• Echinocandins
• Lipopeptides
• Fluconazole
• Flucytosine
• Caspofungin

Topics

• Administration, Oral
• Adult
• Antifungal Agents (administration & dosage, therapeutic use)
• Candidiasis, Invasive (therapy, urine)
• Caspofungin
• Combined Modality Therapy
• Drug Resistance, Fungal
• Echinocandins (administration & dosage)
• Fluconazole (therapeutic use)
• Flucytosine (administration & dosage)
• Humans
• Kidney Calices (pathology, surgery)
• Lipopeptides
• Male
• Therapeutic Irrigation (methods)
• Urinary Catheterization (methods)
• Urinary Tract Infections (therapy)