{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:04:24Z","timestamp":1788447864528,"version":"build-2803163510"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Candida glabrata<\/jats:italic>\n                      is the second leading cause of invasive candidiasis worldwide and represents a major clinical challenge due to its intrinsic antifungal resistance, stress tolerance, and ability to persist in hostile host environments. We report a complex case of multidistrict\n                      <jats:italic>C. glabrata<\/jats:italic>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      <jats:italic>C. glabrata<\/jats:italic>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This case highlights the challenges of treating multidistrict\n                      <jats:italic>Candida glabrata<\/jats:italic>\n                      infections and underscores the potential role of echinocandin\u2013liposomal amphotericin B combination therapy when pharmacokinetic barriers may limit the effectiveness of antifungal monotherapy.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1796594","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T05:25:53Z","timestamp":1776317153000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Multidistrict invasive Candida glabrata infection successfully treated with echinocandin and liposomal amphotericin B combination therapy: a case report and therapeutic perspective"],"prefix":"10.3389","volume":"13","author":[{"given":"Massimo","family":"Caracciolo","sequence":"first","affiliation":[{"name":"UOSD Post-Operative Intensive Care Unit, Great Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d","place":["Reggio Calabria, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"D\u2019Aleo","sequence":"additional","affiliation":[{"name":"Clinical Microbiology and Virology Unit, Great Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d","place":["Reggio Calabria, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Francesca","family":"Stagno","sequence":"additional","affiliation":[{"name":"UOSD Post-Operative Intensive Care Unit, Great Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d","place":["Reggio Calabria, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmelo","family":"Papola","sequence":"additional","affiliation":[{"name":"Clinical Microbiology and Virology Unit, Great Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d","place":["Reggio Calabria, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Pellicano","sequence":"additional","affiliation":[{"name":"UOSD Post-Operative Intensive Care Unit, Great Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d","place":["Reggio Calabria, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna Maria","family":"Nicol\u00f2","sequence":"additional","affiliation":[{"name":"Clinical Microbiology and Virology Unit, Great Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d","place":["Reggio Calabria, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Antonella","family":"Caracciolo","sequence":"additional","affiliation":[{"name":"UOC Perioperative and General Anaesthesia and Intensive Care, Senese University Hospital","place":["Siena, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonino","family":"Ripepi","sequence":"additional","affiliation":[{"name":"UOSD Post-Operative Intensive Care Unit, Great Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d","place":["Reggio Calabria, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Pellicano","sequence":"additional","affiliation":[{"name":"UOSD Post-Operative Intensive Care Unit, Great Metropolitan Hospital \u201cBianchi 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Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1128\/CMR.12.1.80","article-title":"Candida glabrata: review of epidemiology, pathogenesis, and clinical disease","volume":"12","author":"Fidel","year":"1999","journal-title":"Clin Microbiol Rev"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1128\/JCM.06112-11","article-title":"Frequency of decreased susceptibility and resistance to echinocandins among fluconazole-resistant bloodstream isolates of Candida glabrata","volume":"50","author":"Pfaller","year":"2012","journal-title":"J Clin Microbiol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/cid\/civ933","article-title":"Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of 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