What is it about?
Fungal infections of the spine are rare but very hard to treat, often requiring 6-12 months of therapy and surgery. We describe a 66-year-old man who, after complicated prostate surgery with bowel and bladder perforation, peritonitis and septic shock, developed Candida albicans infections in the abdomen and blood, and months later a Candida infection of the lower spine. Despite appropriate treatment with fluconazole and then liposomal amphotericin B, the infection did not improve. We then used rezafungin, a new echinocandin antifungal that needs to be given intravenously only once a week, allowing treatment at home. After eight weeks, MRI and PET/CT showed clear improvement, blood fungal markers became negative and the drug was well tolerated, so he could switch to oral fluconazole.
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Why is it important?
This is the first reported use of rezafungin to treat Candida albicans spondylodiscitis, and the first in an outpatient setting. Its weekly dosing, good activity against biofilms and favourable tolerability make it an attractive salvage option for complex fungal bone infections and for home intravenous therapy programmes.
Perspectives
This patient had a long and difficult journey, and rezafungin gave us a new option when we were running out of them, while allowing him to be treated at home. The case is also the result of a valuable cross-border collaboration with Nina Grasselli Kmet from Ljubljana, a reminder of how close Trieste and Slovenia are in clinical practice too.
Professor Stefano Di Bella
Universita degli Studi di Trieste
Read the Original
This page is a summary of: Salvage therapy of complicated Candida albicans spondylodiscitis with Rezafungin, European Journal of Clinical Microbiology & Infectious Diseases, March 2025, Springer Science + Business Media,
DOI: 10.1007/s10096-025-05117-5.
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