Multidistrict invasive Candida glabrata infection successfully treated with echinocandin and liposomal amphotericin B combination therapy: a case report and therapeutic perspective

Introduction: infection in a 39-year-old immunocompetent male who presented with septic shock secondary to gastric perforation and thoracic contamination. Despite guideline-recommended echinocandin therapy, persistent fungal growth was detected in multiple anatomical compartments, including bloodstream, pleural fluid, surgical wound, and bronchoalveolar lavage samples. Methods: Serial cultures and antifungal susceptibility testing were performed using MALDI-TOF MS and interpreted according to CLSI criteria. Radiological monitoring, surgical source control, and pharmacokinetic considerations guided therapeutic decisions. Results: isolates showed reduced azole susceptibility but remained susceptible to echinocandins and amphotericin B. Persistent fungal growth between postoperative day (POD) 8 and POD 16 prompted escalation from caspofungin to micafungin and subsequently to combination therapy with liposomal amphotericin B. Rapid clinical improvement followed initiation of dual therapy, with microbiological clearance by POD 20 and complete recovery by POD 30. Conclusion: infections and underscores the potential role of echinocandin-liposomal amphotericin B combination therapy when pharmacokinetic barriers may limit the effectiveness of antifungal monotherapy.