Successful ventilator weaning after aerosolized liposomal amphotericin B in persistent <i>Candida glabrata</i> colonization: a case report.

Abstract

<h4>Background</h4>Invasive candidiasis and persistent fungal colonization of the airways are increasingly recognized as potential barriers to successful weaning from mechanical ventilation in critically ill patients. Among <i>non-albicans Candida species</i>, <i>Candida glabrata</i>, recently reclassified as <i>Nakaseomyces glabrata,</i> is particularly challenging due to its unique mechanisms of resistance and immune evasion. The use of aerosolized liposomal amphotericin B (Ambisome®) offers a promising local therapeutic approach, combining targeted delivery with a favorable safety profile.<h4>Case presentation</h4>We present the case of a 68-year-old man who required prolonged mechanical ventilation following an ischemic stroke and subsequently developed persistent bronchial colonization by <i>Candida glabrata</i>. Despite systemic antifungal therapy, the colonization persisted, and pulmonary compliance remained poor. The administration of aerosolized liposomal amphotericin B (10 mg BID for 10 days) led to significant improvement in respiratory mechanics and allowed for successful weaning from the ventilator. Follow-up cultures confirmed microbiological clearance.<h4>Conclusion</h4>This case highlights the potential role of aerosolized liposomal amphotericin B as an effective and well-tolerated treatment for persistent fungal airway colonization by <i>C. glabrata</i>, even in non-immunocompromised ICU patients.