Rezafungin for Salvage or Consolidation Therapy of Invasive Fungal Disease: Experience in Real‐World Clinical Practice

BACKGROUND: Echinocandins are the first-line treatment for invasive candidiasis. Rezafungin is a novel echinocandin with improved pharmacokinetic properties that allow for once-weekly intravenous administration, offering potential advantages in complex clinical settings. OBJECTIVES: We aimed to describe our real-world experience with rezafungin for the treatment of invasive fungal disease (IFD). PATIENTS: A retrospective analysis of consecutive patients treated with rezafungin for proven IFD at our center between September 2022 and December 2025 was conducted. RESULTS: We included 13 patients (mean age: 59.4 ± 17.8 years). Main predisposing conditions included immunosuppression (53.8% [solid organ transplantation in 30.8%]), solid cancer (30.8%) and recent surgical intervention (38.5%). Most frequent Candida species were C. albicans (38.5%), C. parapsilosis (30.8%) and Nakaseomyces glabratus (15.4%). One patient had necrotizing gingival infection due to Trichoderma longibrachiatum. Main types of IFD included intravascular Candida infection (38.5%) and surgical-site and intra-abdominal candidiasis (23.1% each). Reported reasons for initiating rezafungin were the presence of fluconazole-resistant isolates (53.8%), facilitating outpatient antifungal therapy (30.8%) and avoiding anticipated drug-drug interactions with triazoles (15.4%). No patient received rezafungin as a first-line treatment and most (92.3%) had been previously exposed to other echinocandins. Rezafungin was typically initiated upon clearance of follow-up blood cultures (80.0%). Median number of weekly doses was 4.0 (interquartile range: 3.0-5.5). Clinical cure (complete or partial response) by day +30 was achieved in all evaluable patients (100.0% [12/12]), with no treatment-emergent adverse events. CONCLUSIONS: Rezafungin was effective and safe as salvage or consolidation therapy in patients with IFD, including deep-seated candidiasis.