P269 Managing prosthetic valve endocarditis due to Sarocladium kiliense: Finding a way through uncertainties

POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM: OBJECTIVE: To discuss the challenges in a case of recurrent/refractory prosthetic valve endocarditis due to Sarocladium kiliense. METHODS AND RESULTS: Timeline of events (Fig. 1). AUC/MIC is associated with efficacy. Recent clinical studies have incorporated the MIC into targets for TDM, wherein Trough/MIC target of 2-5 may be usedR. In this case Voriconazole trough—3.1/MIC-0.25 = 12.5 Usual posaconazole trough—1.2/MIC 0.5 = 2.4, which is at the lower limit of the PKPD index Hence voriconazole was used. Drug interactions of voriconazole with acenocoumarol, clopidogrel were considered. Beta D-Glucan was used to assess infection of the newly implanted valve as well as improvement and need for continuing treatment. Since it is difficult to be certain of a cure, the patient was advised voriconazole as lifelong chronic suppressive therapy with periodic follow-up. R: reference available. CONCLUSIONS: The patient's status of the third mitral prosthetic valve necessitated all efforts to avoid further surgery. Therefore, the most efficacious agent had to be selected based on PK PD considerations and the likelihood of major long-term adverse effects. Careful management of DDI was needed. BDG may help to assess recurrence and response to treatment.