Rezafungin for suppressive therapy of Candida auris in a patient with a left ventricular assist device (LVAD).

INTRODUCTION: Invasive candidiasis is a common healthcare-associated infection with significant morbidity and mortality. Candida auris in particular has emerged as a problematic and challenging healthcare-associated infection, especially with regards to infections involving left ventricular assist devices (LVADs). There is a paucity of evidence on the best management of these particular types of infections. Rezafungin is a newly-approved echinocandin and an important new tool in the management of invasive candidiasis. We report the novel use of rezafungin for suppressive therapy in a patient with an LVAD-associated C. auris infection.

CASE: The patient is a 57-year-old male with a past medical history most notable for heart failure with ischemic cardiomyopathy. The patient underwent LVAD placement and his post-LVAD placement clinical course was notable for recurrent C. auris fungemia. The patient was originally on indefinite micafungin therapy, but was eventually switched to once-weekly rezafungin as this was felt to be safer, easier, and more convenient for the patient. He did well on weekly rezafungin for about 4 months but did eventually develop breakthrough C. auris fungemia.

CONCLUSIONS: Rezafungin is a promising new antifungal in the armamentarium of drugs for treatment of invasive candidiasis, notably C. auris. Though the patient did develop a breakthrough C. auris bloodstream infection while on rezafungin therapy, his infection was well-controlled for a little over 4 months, which prevented any C. auris-related hospital admissions during that time period. This case represents the first example of rezafungin being used for an LVAD-associated C. auris infection.