Caspofungin in the treatment of Candida auris candiduria in Hemato-oncological Patients: An observational retrospective cohort study.

Abstract

Candiduria is a common problem especially in advanced stage oncology/hematology cases. Herein, we aimed to analyze the efficacy of caspofungin treatment in Candida auris isolated from urine culture. We conducted an observational retrospective study in a tertiary-care educational hemato-oncology hospital from October 2021 to November 2022. The patients hospitalized in our center and having at least two consecutive urine cultures that yielded C. auris with significant pyuria were included in the study. The effectiveness of caspofungin was evaluated based on clinical and microbiological outcomes. In total, 10 patients (two female, aged 55.3 ± 15) were included in the study. Four (40%) patients had urinary tract infections, and six (60%) patients had asymptomatic C. auris candiduria which required antifungal therapy. Nine cases had urinary instrumentation: two nephrostomy, one suprapubic catheter, and six urinary catheters. The 10 cases received a mean of 13.4 ± 3.5 days of caspofungin. Four of 10 cases (40%) had at least 1 negative culture between day 1 and the end of caspofungin treatment. Relapse and re-infection rates 30 days after the end of therapy in microbiologically successful cases were 3/4 and 2/4. Caspofungin resistance developed in three cases (30%) within 30 days after treatment. Overall day-30 mortality was 3/10 (30%) while overall success (microbiological success + no relapse/reinfection during 30 days follow up after end of therapy) was 10%. Caspofungin demonstrated limited efficacy in treating C. auris-related urinary tract infection/colonization in hospitalized cancer patients.