Rezafungin in the management of patients with Candida osteoarticular infections: Results from the REZ-GEIO project

To evaluate the use and the outcomes of patients with Candida osteoarticular infections (OAIs) who received rezafungin in real-world practice.

This is a prospective study conducted in nine Spanish hospitals since 2023. Patients who received rezafungin for Candida OAIs were included. Variables analysed were clinical, types of OAIs, surgical and antimicrobial treatments. The primary outcome was clinical success 1-y after the first rezafungin administration. Secondary outcomes included microbiological success, reasons for clinical failure, and the occurrence of adverse events (AEs).

Seventeen patients were included: mean age was 65.8 y (SD 18.5), 58.8% were females and 35.3% had immunosuppression. In total 13 patients (76.5%) had prosthetic joint infection (PJI): seven early postoperative and six late chronic. The most frequent Candida spp. were C. albicans (52.9%) and C. glabrata (23.5%). For the primary outcome 15 patients who had at least 1-y of follow-up were analysed: among them, 9 cases (60.0%) had clinical success. Considering the PJI cases, clinical success was 66.7%. Patients with clinical success presented a non-statistically significant higher number of total surgeries (mean 2.3 vs. 1.8, P = 0.14) and more doses of rezafungin (mean 14.0 vs. 6.3, P = 0.36). As for the secondary outcomes, microbiological success was 100%. Reasons for failures were three non-OAI related deaths, two re-infections and one case who underwent amputation because of critical limb ischemia. Six patients presented AEs; none were rezafungin related.

Rezafungin represents an effective and safe treatment for Candida spp. OAIs, especially for PJI, with no related microbiological failures or AEs.