Aim. To present our experience of high- dose micafungin treatment of late onset fluconazole resistant Candida albicans sepsis in an ELBW preterm infant.

Methods and results. Consideration of a case report of a nine day-old prematurely born female infant, 600 g in weight (birth weight 610 g , 24 week gestational age ) admitted to our unit with right side pneumothorax due to respiratory distress, patent ductus arteriosus, septic, with acute renal failure, necrotising enterocolitis (II b – to Bell’s criteria), hypotensive, hyperglycemic, with intraventricular haemorrhage gr III, on polivalent antibiotics and fluconazole since birth. Intraumbilical vein catheter was placed after birth, parenteral nutrition established. Cultures from blood and umbilical catheter were positive for C. albicans, fluconazole resistant. After removing umbilical catheter, antifungal drug therapy was stated with micafungin 10 mg/kg/day for five days. After two days of treatment blood culture was negative for C. albicans, and remained negative until hospital release; clinical condition improved. Two days after micafungin was completed her clinical condition deteriorated again. Because gram negative sepsis was suspected, meropenem was introduced and caspofungin as antifungal prophylaxis, for the next 14 days. Taking into consideration the concern regarding side effects and potential micafungin toxicity, on day 10 after completing micafungin therapy, our patient developed severe trombocytopenia which lasted 30 days. Due to extensive side therapy, followed by positive antiTrc pt IgG (IF) direct and indirect tests, it is difficult to strictly determine the trombocytopenia as micafungin related. Signs of hepatotoxicity were not found. At the age of 47 weeks postconceptual, the infant was released. She weighed 3,740 g and was in good clinical and neurological condition with normal laboratory values.

Conclusion. In our experience high-dose micafungin therapy was safe and effective.

Kondža Karmen,
Children's Hospital Zagreb, Klaićeva 16, 10 000 Zagreb

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