1. ¹Department of Pediatrics, Duke University, Durham, NC, USA
2. ²Duke University Clinical Research Institute, Durham, NC, USA
3. ³Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, USA
4. ⁴Department of Medicine, Duke University, Durham, NC, USA
5. ⁵National Cancer Institute, Bethesda, MD, USA

Correspondence: Dr PB Smith, Duke University Medical Center, Durham, Box 3179, NC 27710, USA. E-mail: smith466@mc.duke.edu

Received 14 August 2006; Revised 9 October 2006; Accepted 31 October 2006.

Abstract

Candidemia is common in extremely low birth weight infants and is associated with substantial mortality and morbidity. Treatment options have traditionally been limited to amphotericin B deoxycholate or fluconazole. We present a case of a premature infant with persistent candidemia despite antifungal treatment that responded to therapy with caspofungin, an echinocandin antifungal. The infant's Candida isolate developed resistance to azoles during fluconazole administration and also suffered from severe hypercalcemia during the initiation of caspofungin therapy.