Rezafungin and catheter-related candidemia: a new player in a high-stakes game

Candidemia remains a significant healthcare-associated infection characterized by high mortality rates and considerable resource utilization. While echinocandins are established as first-line treatment, extended daily intravenous administration often delays patient discharge, particularly when transitioning to oral azoles is not feasible. Rezafungin, a novel long-acting echinocandin, offers once-weekly dosing with predictable pharmacokinetics. This prospective observational pilot study examined consecutive cases of guideline-defined catheter-related candidemia (CRC) diagnosed in medical wards at two Italian hospitals in 2025. All subjects initially received short-acting echinocandin therapy alongside catheter removal for source control. Upon meeting predefined clinical and microbiological stability criteria, patients were administered a single dose of rezafungin on day 7. Primary outcomes included clinical success and microbiological clearance at 30 days. Secondary endpoints encompassed reductions in hospital length of stay, relapse rates, mortality, and adverse drug events. Seven patients received rezafungin as consolidation therapy. The cohort was characterized by advanced age and a high comorbidity burden. Microbiological eradication was achieved in all cases. No drug-related adverse events, relapses, or deaths were observed at 30- and 90-day follow-up. The median estimated decrease in hospital stay was four days, translating to 28 bed-days saved. This real-world pilot cohort demonstrated that a stepwise antifungal strategy incorporating rezafungin following initial echinocandin therapy is feasible, well-tolerated, and associated with favorable short-term outcomes. Such an approach may facilitate earlier patient discharge, mitigate vascular-access issues, and support more efficient management of catheter-related candidemia. Larger, multicenter controlled studies are necessary to verify the clinical, economic, and sustainability benefits.