Echinocandins for candidemia in adults without neutropenia

A 62-year-old man was admitted to the intensive care unit (ICU) with severe community-acquired pneumonia. On the sixth hospital day, he remained intubated and was receiving broad-spectrum antibiotics for his pneumonia when an episode of hypotension occurred, requiring volume expansion and the administration of vasopressors. The patient had diffuse pulmonary infiltrates and a serum creatinine level of 3 mg per deciliter (265 μmol per liter) and required mechanical ventilation with an oxygen concentration of 50%. Three days later, a blood culture of a specimen obtained from his venous catheter was reported to be growing candida species other than Candida albicans. An infectious disease consultant recommended that the central venous catheter be removed and replaced in another site and that treatment with caspofungin be initiated.