This conference centers on a patient with ESRD on hemodialysis, severe pulmonary hypertension, chronic lung disease, and prior TAVR who presented with chills and was found to have Candida glabrata fungemia. Initial transthoracic echo was limited and unrevealing, but transesophageal echo showed a mobile density on the transcatheter aortic valve, creating a high-stakes prosthetic valve endocarditis problem in a patient with very high operative risk.
The teaching portion reviews management decisions in Candida prosthetic valve endocarditis: initial IV antifungal therapy, the role and risk of TEE, how to think about surgery when surgical risk is prohibitive, and what lifelong or prolonged suppressive antifungal therapy means in practice. The final section broadens into suppressive antimicrobial therapy for endocarditis, emphasizing the limited evidence base, observational French experience, multidisciplinary endocarditis teams, tolerability issues, and the uncertainty that remains when cure is not surgically achievable.