ABSTRACT
During a 1-year period, the authors examined clinical experience with drotrecogin alfa, activated for sepsis in a 24-bed medical-surgical intensive care unit. Drotrecogin alfa, activated was administered 46 times to 44 patients (3% of all intensive care unit admissions). Eighty-six percent of patients were on vasopressors; 95% were mechanically ventilated. Mean Acute Physiology and Chronic Health Evaluation II score was 22.0 at admission and 21.9 during the 24 hours before drug administration. The 28-day all-cause mortality was 36.4% and hospital mortality was 43.2%, trending higher (P = .10) than in the PROWESS study, which can be attributed to clinical use in patients who would not have met PROWESS study inclusion criteria. Failure to complete a 96-hour infusion of drotrecogin alfa, activated and transfer from another hospital or nursing home before treatment were associated with poor outcome. Total cost of hospital care, including mean drotrecogin alfa, activated drug cost of 7,312 US dollars, exceeded reimbursement by a mean of 18,227 US dollars.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Protein C/therapeutic use , Systemic Inflammatory Response Syndrome/drug therapy , Adult , Aged , Anti-Inflammatory Agents, Non-Steroidal/economics , Drug Costs , Female , Humans , Male , Middle Aged , Patient Selection , Protein C/economics , Recombinant Proteins/economics , Recombinant Proteins/therapeutic use , Systemic Inflammatory Response Syndrome/economics , Systemic Inflammatory Response Syndrome/mortality , Treatment OutcomeABSTRACT
OBJECTIVE: Systemic fungal infections have high mortality, and therapy is often toxic. Caspofungin acetate, a new antifungal agent with minimal toxicity, may provide a better alternative to typical therapy for Candida krusei. DESIGN: Case report. SETTING: Multidisciplinary intensive care unit (ICU) of a community teaching hospital. PATIENT: A 22-yr-old male with acute lymphoblastic leukemia and Candida krusei fungemia failed therapy with fluconazole and amphotericin B. INTERVENTIONS: Caspofungin acetate given intravenously as a 70-mg loading dose, followed up by 50 mg daily along with standard ICU care. RESULTS: Survival without toxicity from therapy. CONCLUSION: Efficacy of caspofungin acetate in a patient with life-threatening Candida Krusei infection.