Successful ventilator weaning after aerosolized liposomal amphotericin B in persistent Candida glabrata colonization:
Massimo Caracciolo1, Simona Pellicano1, Sarah Antonella Caracciolo2
1UOSD Post-Operative Intensive Care Unit, Great Metropolitan Hospital Bianchi Melacrino Morelli, Reggio Calabria, Italy.
Background:
Invasive candidiasis and persistent fungal colonization of the airways are increasingly recognized as potential barriers to successful weaning from mechanical ventilation in critically ill patients. Among non-albicans Candida species, Candida glabrata, recently reclassified as Nakaseomyces glabrata, is particularly challenging due to its unique mechanisms of resistance and immune evasion. The use of aerosolized liposomal amphotericin B (Ambisome®) offers a promising local therapeutic approach, combining targeted delivery with a favorable safety profile.
Case Presentation:
We present the case of a 68-year-old man who required prolonged mechanical ventilation following an ischemic stroke and subsequently developed persistent bronchial colonization by Candida glabrata. Despite systemic antifungal therapy, the colonization persisted, and pulmonary compliance remained poor. The administration of aerosolized liposomal amphotericin B (10 mg BID for 10 days) led to significant improvement in respiratory mechanics and allowed for successful weaning from the ventilator. Follow-up cultures confirmed microbiological clearance.
Conclusion:
This case highlights the potential role of aerosolized liposomal amphotericin B as an effective and well-tolerated treatment for persistent fungal airway colonization by C. glabrata, even in non-immunocompromised ICU patients.
Insights
Aerosolized liposomal amphotericin B effectively treated persistent Candida glabrata airway colonization in a critically ill patient. This approach aided successful mechanical ventilation weaning, demonstrating a promising local therapy for challenging fungal infections.
Area of Science:
- Critical Care Medicine
- Mycology
- Pulmonology
Background:
- Invasive candidiasis and airway colonization by non-albicans Candida species, particularly Nakaseomyces glabrata (formerly Candida glabrata), pose significant challenges in critically ill patients requiring mechanical ventilation.
- N. glabrata presents unique resistance and immune evasion mechanisms, complicating treatment strategies.
- Aerosolized liposomal amphotericin B (Ambisome®) is explored as a targeted local therapy with a favorable safety profile.
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