Innovative Therapy with Caspofungin.

A 68 year old gentleman suffered subarachnoid and intra-ventricular hemorrhage due to a basilar artery aneurysm, which was clipped. He needed multiple changes of external ventricular drain and Ommaya reservoir due to blocks. This led to nosocomial Candida albicans meningitis which was worsening despite 10 days of treatment with L AmB and 5FC to which the organism was susceptible. The susceptibilities were as follows. 5FC <1, AmB = 1, Fluconazole <1, Voriconazole <0.12, Caspofungin <0.25, Micafungin <0.06 mcg/ml.