title: Candida glabrata prosthetic valve endocarditis treated successfully with fluconazole plus caspofungin without surgery: a case report and literature review.
abstract: Reported here is the case of a 72-year-old man who was diagnosed with Candida glabrata prosthetic mitral valve endocarditis and treated successfully with fluconazole plus caspofungin after he refused and was determined unfit for surgery. Initial treatment with intravenous amphotericin B resulted in acute renal impairment. Despite 8 days of intravenous fluconazole therapy, he remained fungemic. Caspofungin was added to the treatment regimen with subsequent sterilisation of blood culture. The patient was treated for 34 days with caspofungin and 41 days with fluconazole. He continued oral fluconazole after hospital discharge and remained well at follow-up 11 months later. The role of fluconazole and caspofungin in the treatment of Candida endocarditis is discussed.
authors.affiliation: Department of Infectious Diseases, Level 7, Geelong Hospital, Ryrie Street, PO Box 281, Geelong, 3220, Victoria, Australia.
authors.forename: D C B
authors.initials: DC
authors.lastname: Lye
authors.forename: A
authors.initials: A
authors.lastname: Hughes
authors.forename: D
authors.initials: D
authors.lastname: O'Brien
authors.forename: E
authors.initials: E
authors.lastname: Athan
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D000368:Aged; D000666:Amphotericin B / Q000009:adverse effects / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D041221:Candida glabrata; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology; D000077336:Caspofungin; D004359:Drug Therapy, Combination; D054714:Echinocandins; D004696:Endocarditis / Q000188:drug therapy* / Q000382:microbiology; D015725:Fluconazole / Q000627:therapeutic use*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D055666:Lipopeptides; D008297:Male; D008943:Mitral Valve / Q000382:microbiology / Q000601:surgery; D010456:Peptides, Cyclic / Q000627:therapeutic use*; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D000666:Amphotericin B; D015725:Fluconazole; D000077336:Caspofungin