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

F. Morlini¹, F. Pezone¹, M. Alessio-Mazzola², V. Salini¹, G. Placella¹

¹Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy
²IRCCS Ospedale San Raffaele, Via Olgettina 60, Milan, Italy

Correspondence to:
Mattia Alessio Mazzola, MD
IRCCS Ospedale San Raffaele,
Via Olgettina 60,
20132, Milan. Italy
e-mail: mattia.alessio@hotmail.com

Received: 2 March, 2026 Accepted: 13 April, 2026

ISSN 2975-044X (online) ISSN 2038-4106 (print) Copyright © by LAB PUBLISHERS 2026 This publication and/or article is for individual use only and may not be further reproduced without written permission from the copyright holder. Unauthorized reproduction may result in financial and other penalties. Disclosure: All authors report no conflicts of interest relevant to this article.

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