gms | German Medical Science

Background: The aim of this study is to evalute the role of caspofungin in the treatment of fungal pneumonia (FP).

Patients and methods: Patients who received caspofungin for the treatment of fungal pneumonia (FP) between January 2009 and December 2011 were identified from the hospital pharmacy records. FP was categorized based on the criteria of European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC/MSG) [1]. Possible FP was defined as radiological findings (dense, well-circumscribed nodular lesion(s) with or without a halo sign, air-crescent sign, and cavitary lesion) concordant with FP without microbiological evidence. Probable FP was defined as radiological finding concordant with FP and serum GM >0.5 or BDG >80 pg/mL, or isolation of molds from respiratory samples. Proven FP was defined as detection of hypha or isolation of mold species from lung biopsies. Responses to treatment and survival were assessed at the end of therapy. Success was defined as radiological stabilization (defined as a 0%–25% reduction in the diameter of the lesion), resolutionof all attributable symptoms and signs of fungal disease. Failure was defined as deterioration of attributable clinical or radiographic abnormalities necessitating alternative antifungal therapy or death during the treatment period regardless of attribution [2].

Results: Sixty-eight patients were included in the study. The median age of the patients were 46 years and 41 of them were male. The 63 of the patients had hematological malignancy and underlying disease was not in remission for 32 patients. One patient had proven FP, 36 had probable FP, and 31 had possible FP according to EORTC/MSG criteria. 28 out of 68 patients received caspofungin as the primary treatment while 40 received caspofungin as salvage therapy. Median duration of therapy was 15 days (interquartile range; 11-20.7 days). The overall success was 44.1% (30 of 68). There were no statistically significant differences in terms of clinical and demographic characteristics of the patients according to treatment responses. Caspofungin success rate was higher in in salvage treatment group than primary treatment (56.7% vs 43.3%). However, there was no statistically significant diffrences between two groups (p=0.807). The six week survival rate was higher in patients who had a good clinical response when compared with the patients who had failure (86.7%vs 31.6%,p<0.05).

Conclusion: Reserving caspofungin for the treatment of FP refractory to other antifungal agents seems to be a reasonable approach for the optimal management of invasive fungal infections.