Rezafungin for suppressive therapy of Candida auris in a patient with a left ventricular assist device (LVAD)
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Published on: May 12, 2020
Matthew A Stack1,2, Luis Ostrosky-Zeichner1, Rodrigo Hasbun1
1University of Texas Health Science Center at Houston, USA.
Introduction:
Invasive candidiasis is a common healthcare-associated infection with significant morbidity and mortality. Candida auris in particular has emerged as a problematic and challenging healthcare-associated infection, especially with regards to infections involving left ventricular assist devices (LVADs). There is a paucity of evidence on the best management of these particular types of infections. Rezafungin is a newly-approved echinocandin and an important new tool in the management of invasive candidiasis. We report the novel use of rezafungin for suppressive therapy in a patient with an LVAD-associated C. auris infection.
Case:
The patient is a 57-year-old male with a past medical history most notable for heart failure with ischemic cardiomyopathy. The patient underwent LVAD placement and his post-LVAD placement clinical course was notable for recurrent C. auris fungemia. The patient was originally on indefinite micafungin therapy, but was eventually switched to once-weekly rezafungin as this was felt to be safer, easier, and more convenient for the patient. He did well on weekly rezafungin for about 4 months but did eventually develop breakthrough C. auris fungemia.
Conclusions:
Rezafungin is a promising new antifungal in the armamentarium of drugs for treatment of invasive candidiasis, notably C. auris. Though the patient did develop a breakthrough C. auris bloodstream infection while on rezafungin therapy, his infection was well-controlled for a little over 4 months, which prevented any C. auris-related hospital admissions during that time period. This case represents the first example of rezafungin being used for an LVAD-associated C. auris infection.
Insights
Rezafungin, a new antifungal, was used for suppressive therapy in a patient with a left ventricular assist device (LVAD) and Candida auris infection. While breakthrough fungemia occurred, the therapy provided over four months of infection control.
Area of Science:
- Infectious Diseases
- Cardiology
- Pharmacology
Background:
- Invasive candidiasis, particularly Candida auris, poses a significant threat in healthcare settings, especially in patients with left ventricular assist devices (LVADs).
- Management strategies for Candida auris infections in LVAD patients are not well-established.
- Rezafungin, a novel echinocandin, offers a new therapeutic option for invasive candidiasis.
Observation:
- A 57-year-old male with an LVAD experienced recurrent Candida auris fungemia.
- Initial treatment with micafungin was switched to weekly rezafungin for improved safety and convenience.
- The patient remained stable on rezafungin for approximately four months before breakthrough fungemia occurred.
Findings:
- This case details the first reported use of rezafungin for suppressive therapy in a patient with an LVAD-associated Candida auris infection.
- Rezafungin provided effective control of the infection for over four months, preventing hospital admissions.
- Despite a breakthrough infection, rezafungin demonstrated potential utility in managing complex Candida auris cases.
Implications:
- Rezafungin represents a promising new agent for invasive Candida auris infections, including those in challenging patient populations like LVAD recipients.
- This case highlights the potential role of rezafungin in suppressive therapy for recurrent or difficult-to-treat candidiasis.
- Further research is warranted to establish optimal dosing and long-term efficacy of rezafungin in LVAD-associated infections.
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