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

## TL;DR

A 13-year-old boy with a fungal bloodstream infection and heart valve infection was successfully treated with caspofungin after failing itraconazole.

## Contribution

Demonstrates successful caspofungin treatment for itraconazole-resistant Candida glabrata prosthetic valve endocarditis.

## Key findings

- Caspofungin effectively treated a case of itraconazole-resistant Candida glabrata bloodstream infection and endocarditis.
- Antifungal susceptibility testing was critical in guiding treatment decisions for this complex infection.

## Abstract

Candidemia is a prevalent nosocomial bloodstream infection with a high mortality rate. Involvement of heart valves by Candida spp. after candidemia can result in native and prosthetic valve endocarditis as biofilm-related infections.

This report aimed to introduce a case of a 13-year-old male with bloodstream infection and prosthetic valve endocarditis, caused by itraconazole-resistant Candida glabrata (Nakaseomyces glabratus). Despite undergoing itraconazole for 4 weeks, the patient did not improve.

White colonies were identified as C. glabrata (N. glabratus) by Restriction Fragment Length Polymorphism-Polymerase Chain Reaction. The isolate was resistant to itraconazole (MIC=8 µg/mL) but susceptible to amphotericin B and caspofungin. Based on concerns about biofilm-related resistance, treatment was switched to caspofungin for 5 weeks. He continued to do well and showed no signs of relapse during his 6-month follow-up.

This study explored the importance of antifungal susceptibility testing in handling complicated infections, as well as the potential of caspofungin in the treatment of cases of fungal bloodstream infections and endocarditis.