Caspofungin or Micafungin as Empiric Antifungal Therapy for Persistent Fever and Neutropenia

Objectives This retrospective cohort analysis of converting from caspofungin to micafungin as empiric antifungal therapy for cancer patients who are persistently febrile and neutropenic after receiving broad spectrum antibiotics at Brigham \& Women's Hospital / Dana Farber Cancer Institute (BWH/DFCI) is designed to evaluate the following objectives: * Safety of micafungin in this patient population * Effective dose of 100 mg daily of micafungin compared to 70mg x1, then 50 mg daily of caspofungin * Economic impact of converting or formulary echinocandin from micafungin to caspofungin Study Design * Retrospective cohort analysis - limited to medical records * Data to be collected include the following: * Demographic information: including: gender, age, race * Past medical history and admitting diagnoses * Laboratory results: Liver function tests (LFTs), Including alanine aminotransferase (ALT), aspartate aminotransferase (AST), Total bilirubin, as well as serum fungal assays: Serum Galactomannan assay, 1.3-BD Glucan assay * Concomitant medications and duration of therapy for all systemic: antibiotics and antifungals * All invasive breakthrough fungal infection details, including speciation and outcomes during echinocandin therapy * Dosing, duration, and adverse events associated with echinocandin therapy