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Caspofungin therapy in prosthetic valve endocarditis and candidemia due to itraconazole-resistant Candida glabrata (Nakaseomyces glabratus): A case report

Summary

A 13-year-old boy developed a serious fungal infection on his replacement heart valve after recent surgery. The fungal infection was caused by a type of yeast called Candida glabrata that was resistant to the initial antifungal medication. After testing revealed resistance and biofilm formation, doctors switched to caspofungin, a stronger antifungal drug, and the patient recovered successfully.

Background

Candidemia is a prevalent nosocomial bloodstream infection with high mortality rates up to 40%. Fungal endocarditis caused by Candida species can result in prosthetic valve endocarditis as biofilm-related infections. Non-albicans Candida species, including Candida glabrata, pose treatment challenges due to their pathogenicity and antifungal resistance patterns.

Objective

This case report describes the clinical management of a pediatric patient with prosthetic valve endocarditis and candidemia caused by itraconazole-resistant Candida glabrata. The study aims to highlight the importance of antifungal susceptibility testing and biofilm analysis in guiding appropriate therapy.

Results

The isolate was identified as C. glabrata and showed resistance to itraconazole (MIC=8 µg/mL) but susceptibility to amphotericin B and caspofungin. Following treatment switch to caspofungin for 5 weeks, the patient showed clinical improvement with no relapse during 6-month follow-up.

Conclusion

Antifungal susceptibility testing on both planktonic and biofilm forms is valuable for identifying appropriate medications in complicated Candida infections. Caspofungin demonstrates efficacy as an alternative treatment for prosthetic valve endocarditis caused by itraconazole-resistant C. glabrata even without surgical intervention.
  • Published in:Current Medical Mycology,
  • Study Type:Case Report,
  • Source: PMID: 41122117, DOI: 10.22034/cmm.2025.345248.1615
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