Is there a role for rezafungin in intra-abdominal Candida spp. infections? A case series and literature review.

INTRODUCTION: Intra-abdominal infections caused by Candida spp. (IAC) represent a major clinical challenge requiring a multidisciplinary approach due to difficulties in diagnosis, severity of disease, and the limited availability of therapeutic options. In the field of antifungal therapy, the armamentarium has recently been expanded with rezafungin, a novel echinocandin. The favourable pharmacokinetic and pharmacodynamic profile of rezafungin may support a potential role for this agent in the treatment of IAC. METHODS: We performed a retrospective review of all consecutive patients treated with rezafungin as first- or second-line therapy for IAC during 2025 at IRCCS Humanitas Research Hospital, Rozzano, Italy. In addition, a narrative review of the English-language literature on the role of rezafungin in the management of IAC was conducted. RESULTS: A total of eight patients with IAC were included (75% male; median age [Q1-Q3]: 65 years (61-76)). Six patients were diagnosed with concomitant Candida bloodstream infection. Rezafungin was administered as first-line therapy in 37.5% (3/8) of cases. Microbiological eradication was achieved within 5 days in 50% (4/8), within 14 days in 87.5% (7/8) of patients, including those with incomplete source control. Two patients died within 30 days. No recurrence at 30 days were reported. No adverse events occurred. CONCLUSION: Based on our experience, rezafungin may be considered for the treatment of IAC both as first-line and salvage therapy. Further studies and clinical trials are needed to confirm and support these findings.