WHEN REIMPLANTATION IS NOT AN OPTION: CANDIDA GLABRATA PROSTHETIC KNEE INFECTION MANAGED WITH REZAFUNGIN AND STAGED ARTHRODESIS

¹ Vita-Salute San Raffaele University, Orthopedics and Traumatology Department, Milan, Italy
² IRCCS San Raffaele Hospital, Orthopedics and Traumatology Department, Milan, Italy

Correspondence to:

European Journal of Musculoskeletal Diseases 2026 May-August 15(2): 76-81
https://doi.org/10.82093/ejmd/2026v15iss2_2

Received: 2 March 2026 Accepted: 13 April 2026

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Abstract

Fungal prosthetic joint infections are rare but challenging complications of total knee arthroplasty, particularly when caused by Candida glabrata, a species associated with reduced azole susceptibility. We report a case of chronic C. glabrata prosthetic knee infection following right total knee arthroplasty, complicated by extensive soft-tissue loss and extensor mechanism failure. Microbiological testing demonstrated low echinocandin minimum inhibitory concentrations and intermediate susceptibility to fluconazole. Management prioritized definitive source control through serial surgical debridements and staged fixation, including temporary external fixation and eventual compression knee arthrodesis using crossed cannulated screws. Antifungal therapy was echinocandin-based and included two cycles of once-weekly rezafungin to maintain continuous antifungal coverage across staged procedures, followed by oral voriconazole. The patient also required culture-directed antibacterial therapy for recurrent polymicrobial coinfections, which was discontinued after definitive hardware removal. At the last follow-up, inflammatory markers had normalized, the surgical wound was healed, and radiographic imaging confirmed solid fusion without ongoing antimicrobial therapy. This case highlights the importance of definitive source control in hostile knees and suggests that long-acting echinocandins may facilitate prolonged, guideline-concordant antifungal therapy during complex, staged management of Candida glabrata prosthetic joint infection.

Keywords: Candida glabrata, knee, knee arthroplasty, prosthetic joint infection, tissue loss