Successful Eradication of Candida Parapsilosis Fungemia and Hickman Catheter Salvage with Dual Antifungal Lock Therapy

Introduction: Antifungal Lock Therapy (AfLT) in patients with fungemia and valuable long-term CVCs is an acceptable treatment with catheter salvage about 75%. The common approach locks the catheter with an antifungal agent of a proper solution, at least for 12h/24h, in conjunction with systemic antifungal therapy. Ethanol 70% lock is an alternative approach which could augment the success rate. The aim of the current case report is to present the successful eradication of Candida parapsilosis fungemia and Hickman catheter salvage with Dual AfLT in a pediatric PICU patient.

Patient presentation: A 7mo, 8kg infant (F) was admitted in PICU with severe bronchiolitis. Due to prolonged PICU stay and mechanical complications of prior CVCs (DVT on both femoral veins), a two lumen, 7F, Hickman catheter was inserted on 40^th day. On the 50^th day a Candida parapsilosis fungemia was developed in a screening blood culture (BC) followed by 3 more positive BC till the 54^th day. Peripheral veins were inserted and systemic Liposomal amphotericin B (L-AMB) therapy was started in parallel with AfLT (2mg/ml, 4 ml/each lumen, changed/12h). One day later, to enhance results, ethatol 70% was added (2 ml/each lumen) interchangeably (12h L-AMB/12h ethanol), plus systemic voriconazole.

Results: BC became negative on 2^th treatment day and therapy was continued for additional 14 days. No serious adverse effect was recorded. The patient was discharged with a tracheostomy, spontaneously breathing on 98^th day and remains infection free.

Conclusions: Given the integral role of long-term CVC and the limited venous access in PICU pts, dual AfLT appears to be a promising strategy as an adjunctive therapy for fungemia treatment and catheter salvage.