Micafungin Use in Children: A Tertiary Referral Hospital Experience in the Treatment of Invasive Fungal Infections ; Çocuklarda Mikafungin Kullanımı: İnvaziv Mantar Enfeksiyonlarının Tedavisinde Üçüncü Basamak Merkez Deneyimi

Objective: Invasive fungal infections (IFIs) are a major cause of mortality and morbidity in hospitalized pediatric patients due to limited treatment options. Micafungin has been the most recently approved echinocandin for the treatment of IFIs in children; however, the data on efficacy and adverse events in children has been limited. This study aimed to evaluate the characteristics, treatment responses, and the incidence of adverse events of the micafungin treatment in children. Material and Methods: This retrospective study was designed to evaluate all patients under 18 years old who received micafungin for treatment between January 2017-December 2019. A standardized form was used to collect demographic characteristics, underlying medical conditions, diagnosis of fungal infections, laboratory findings, prognosis, and mortality (14-day mortality, 30-day mortality). Results: We evaluated 43 episodes of 39 patients who received mica-fungin for treatment. Median age of the patients who received mica-fungin for treatment was 2.3 (10 days-17 years and six months) years. Micafungin was used for definitive treatment in 18 (41.9%) patients, for empiric treatment in 15 (34.9%) patients, and for febrile neutrope-nia in 10 (23.3%) patients. Median duration of micafungin treatment was 14 (3-53) days. Treatment efficacy was found as 79.1% in clinical response and 81.3% in mycological response. The incidence of hepat-ic adverse events was 20.9% and renal adverse events 2.3% while using micafungin for treatment. In patients who received micafungin for treatment, 14-day and 30-day mortality rates were 7% and 9.3%, respec-tively. However, these deaths were not attributable to a fungal infection (two patients died due to heart failure, and two patients died due to respiratory failure). Conclusion: We demonstrated that micafungin might be a safe and effective antifungal agent for empiric therapy and definitive therapy. Further and more extensive prospective studies to evaluate the efficiency and safety of micafungin in children ...