The use of linezolid in the treatment of paediatric patients with infections caused by enterococci including strains resistant to vancomycin

A CT scan performed after 20 days demonstrated resolution of pulmonary lesions. The 6 month follow-up was negative. Candida pneumonia is an extremely rare disease, associated with high mortality rates. A pulmonary infection caused by Candida spp. may exist in two forms: a very rare primary pneumonia due to aspiration of oropharyngeal material; and a relatively more common secondary pneumonia due to haema-togenous seeding from a distant site of infection. The predominant origins of septic pulmonary embolism due to Candida spp. are right-sided fungal endocarditis, CVC infection, central venous thrombophlebitis and drug addiction. 2 The presence of Candida in respiratory specimens may be due to contamination and there are no specific clinical and radiological pictures. The clinical syndrome is usually dominated by signs and symptoms of systemic inflammatory syndrome, 3 while the radiographic features include a miliary nodular pattern, with feeding-vessel sign, ground-glass opacity, small nodules or multiple larger nodules with ill-defined borders randomly distributed in bilateral lungs. This pattern was prevalent in the two patients presented here. Other less common CT findings include airspace consolidation, pleural effusion, cavitation and thickening of the bronchial walls. 4 Conclusive diagnosis requires demonstration of the organism in lung tissues. Our two cases were not confirmed by biopsy but certain points strongly favoured the diagnosis: (i) the patients were immunocompromised; (ii) Candida spp. were repeatedly isolated from bronchial samples; (iii) tracheal and bronchial specimen cultures and blood cultures were negative for pyogenic organisms; (iv) PAC cultures were positive for Candida spp; (v) patients failed to respond to ordinary antibiotics; and (vi) there was a good clinical as well as radiological response to antifungal therapy. To date, this is the first report of pulmonary candidiasis treated with anidulafungin therapy. Recently, Crandon et al. 5 studied the bronchopulmonary penetration of intravenous vori-conazole and anidulafungin given in combination in healthy adults, and found good anidulafungin concentrations in alveolar macrophages and optimal lung distribution. Another study found the combination of anidulafungin and voriconazole synergistic at a dosage of 5 mg/kg/day in neutropenic rabbits with experimental invasive pulmonary aspergillosis. 6 These data seem to support the clinical use of this drug alone or in combination with voriconazole for the treatment of Candida lung infections. In conclusion, we have described two cases of bilateral septic pulmonary candidiasis successfully treated with anidulafungin therapy. This report suggests a potential role for anidulafungin in the treatment of pulmonary fungal infections. Funding M. F. …