Outcomes are reported for 6 adults receiving rezafungin for chronic, hard-to-treat, invasive candidiasis (including Candida parapsilosis) during an early access program. Rezafungin was well tolerated and administered via once-weekly outpatient intravenous infusion for up to 39 weeks during the program, enabling hospital discharge and replacing daily antifungal infusions.

An uncommon complication of fungal infection is endocarditis, burdened by higher mortality rates (from 40% to 60% according to different studies) than bacterial endocarditis. Candida spp. accounts for approximately 50% of all fungal endocarditis and its incidence is expected to increase due to advances in the care of patients with underlying malignancy and rheumatologic diseases, within the intensive care units and the increasing use of intravascular or intracardiac device.^1–3 The distribution of Candida species as the aetiology of endocarditis differs from the distribution of candidaemia alone.¹C. glabrata globally constitutes the second leading cause of invasive candidiasis (IC) and its reduced frequency in endocarditis may reflect the lack of several pathogenic attributes.⁴ However, this species has a remarkable propensity to acquire and then express resistance mutations in the presence of selective pressure.⁵ The treatment of candida endocarditis typically involves a combined approach of antifungal therapy (AFT) and surgery.^6–8 The recommended initial AFT regimens are lipid amphotericin B, with or without flucytosine, or a high-dose echinocandin. The proposed duration of AFT is at least 6 weeks and a step-down therapy to an azole in infections caused by azole-susceptible isolates may be considered assuming the patient is clinically stable and has cleared candidaemia.^6–8 Following completion of initial therapy, long-term suppressive AFT is prudent in the setting of prosthetic valve endocarditis or if surgery is not performed.^1,8 Rezafungin is the first molecule of the new generation of long-acting echinocandins. It has several advantages over the already approved echinocandins as it has better stability, pharmacokinetic/phamacodynamic (PK/PD) parameters (half-life > 130 h, minimal interpatient variability and enhanced tissue penetration) and improved safety profile, which would allow higher dose regimes and thus prevent (or reduce) the selection of resistant strains.⁹ STRIVE and ReSTORE trials lead to rezafungin FDA’s approval for the treatment of candidaemia and IC in adult patients who have limited or no alternative treatment options.¹⁰ However, rezafungin has yet to be tested extensively in those forms of IC requiring > 4 weeks of antifungal treatment. In these scenarios the favourable PK/PD characteristics of rezafungin might prove advantageous.

Long-acting antiretroviral therapy (LA-ART) represents an important advancement in HIV care as it has considerably reduced the frequency of dosing and therefore improved adherence

Invasive fungal diseases (IFDs) still represent a relevant cause of mortality in patients affected by hematological malignancies, especially acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) undergoing remission induction chemotherapy, and in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Mold-active antifungal prophylaxis (MAP) has been established as a standard of care. However, breakthrough IFDs (b-IFDs) have emerged as a significant issue, particularly invasive aspergillosis and non-Aspergillus invasive mold diseases. Here, we perform a narrative review, discussing the major advances of the last decade on prophylaxis, the diagnosis of and the treatment of IFDs in patients with high-risk neutropenic fever undergoing remission induction chemotherapy for AML/MDS and allo-HSCT. Then, we present our single-center retrospective experience on b-IFDs in 184 AML/MDS patients undergoing high-dose chemotherapy while receiving posaconazole (n = 153 induction treatments, n = 126 consolidation treatments, n = 60 salvage treatments). Six cases of probable/proven b-IFDs were recorded in six patients, with an overall incidence rate of 1.7% (6/339), which is in line with the literature focused on MAP with azoles. The incidence rates (IRs) of b-IFDs (95% confidence interval (95% CI), per 100 person years follow-up (PYFU)) were 5.04 (0.47, 14.45) in induction (n = 2), 3.25 (0.0013, 12.76) in consolidation (n = 1) and 18.38 (3.46, 45.06) in salvage chemotherapy (n = 3). Finally, we highlight the current challenges in the field of b-IFDs; these include the improvement of diagnoses, the expanding treatment landscape of AML with molecular targeted drugs (and related drug–drug interactions with azoles), evolving transplantation techniques (and their related impacts on IFDs’ risk stratification), and new antifungals and their features (rezafungin and olorofim).

Background: Rezafungin, a novel echinocandin with once‐weekly intravenous dosing, offers potential advantages for outpatient parenteral antifungal therapy (OPAT) in invasive candidiasis (IC). While clinical trial data support its efficacy and safety, real‐world experience remains limited.Methods: A retrospective analysis of patients treated with rezafungin across Germany, Italy, Spain, and the United States between January 2024 and June 2025 was conducted. Data was collected via the FungiScope registry. Clinical characteristics, indications for rezafungin, outcomes, safety, and logistical aspects of administration were evaluated.Results: Fifteen patients were included, fourteen with IC; one with chronic pulmonary aspergillosis. Regarding patients with IC, the median age was 65.5 years; 43% were female. The most frequently identified pathogens were Candida glabrata (57%) and Candida parapsilosis (21%). Primary indications for rezafungin were intravascular (36%) and osteoarticular infections (36%). Rezafungin was mainly selected to enable OPAT (86%) or due to fluconazole resistance (36%) or drug–drug interactions (14%). The median treatment duration was 9 weeks (range: 1–38 weeks). One mild adverse event occurred (cutaneous photosensitivity), but rezafungin was otherwise well tolerated. Complete clinical or mycological response was observed in 36% at day 30, and partial response in 50% of patients. Access differed substantially across centres due to administrative and reimbursement hurdles, affecting treatment transition to rezafungin in 71% of patients with IC.Conclusions: Rezafungin was effective and well tolerated in this cohort, particularly in patients requiring long‐term treatment. Administrative and logistical hurdles remain significant barriers to its widespread use. Facilitated access and enhanced awareness may improve patient outcomes by supporting early initiation and continuity of care.

Nontuberculous mycobacteria are a rare but still emerging cause of difficult-to-treat prosthetic joint infection. To our knowledge only 17 cases of M. abscessus complex prosthetic joint infection are reported in literature, of which only 1 is by M. abscessus subps. abscessus. No guidelines are available for this clinical scenario.