Introduction: The spread of nosocomial fungal infections (NFIs) is associated with a high risk of mortality in intensive care unit (ICU) patients. Over the past 5 years, three molecules with the same mechanism of action, Caspofungin, Anidulafungin and Micafungin, have been approved for the treatment of candidiasis. In this work we examined the differences in their  pharmacodynamic characteristics, which are essential to perform therapeutic decisions.
Materials and Methods: Clinical data were collected from six Italian Hospitals (Chieti - Teramo - San Benedetto del Tronto - Civitanova Marche - Macerata - Pesaro) between January 2013 and December 2013, considering 114 patients with candidiasis from identified fungal species. We analyzed the progressive percentage of inhibition of fungal growth in function of time and the cost of therapies for each of the echinocandins.  
Results: Laboratory tests showed that Caspofungin inhibits fungal growth at third day compared to other molecules. We observed a selectivity of action of each molecule towards the various fungal strains with different response times. Patients treated with Caspofungin required a shorter stay in ICU, reducing the impact of the drug on the total cost of hospitalization. The profiles of inhibition of fungal growth of these drugs were similar for the three molecules.
Discussion: An innovative aspect of this work is that we have tried to reconcile discrepancies in the literature about the choice of correct antifungal therapy to help clinicians to determine a correct therapy for the treatment of NFIs. In this work we have observed a different behavior about growth of fungal strains isolated after echinocandine treatment. In particular, the permanence in ICU is lower for patients treated with Caspofungin compared with Micafungin and Anidulafungin, resulting helpful in savings in terms of costs, considering the expensive cost of hospitalization in the ICU.

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Key words: caspofungin, micafungin, anidulafungin, candidiasis, intensive therapy, treatments cost