Key result
Aggressive antimicrobials and mechanical support enable discharge in severe post-MI coinfection.
Why the study?
Invasive Aspergillus terreus infections and coinfections with Klebsiella pneumoniae following myocardial infarction present diagnostic and therapeutic challenges in critically ill patients.
Case Report (n=1)
Highlights the diagnostic and therapeutic challenges of managing opportunistic fungal and bacterial coinfections in critically ill patients post-myocardial infarction requiring mechanical support.
Does not support practice change for post-MI coinfections; hypothesis-generating for aggressive therapy in rare A. terreus cases.
Background Aspergillus terreus （ A. terreus ）is an opportunistic fungal pathogen increasingly reported among immunocompromised individuals, particularly those admitted to intensive care units (ICUs). Due to its intrinsic resistance to amphotericin B and partial resistance to azoles, treatment remains challenging. Coinfection with bacterial ( Klebsiella pneumoniae [ K. pneumoniae ]) and viral pathogens ( herpes simplex virus type 1 [HSV-1], cytomegalovirus [CMV]) further complicates the clinical course. Case Report We describe a 53-year-old male who developed A. terreus and K. pneumoniae bloodstream infections following acute myocardial infarction (MI). Diagnosis was primarily achieved via next-generation sequencing (NGS) of blood samples, supplemented by clinical and imaging findings. Despite aggressive antimicrobial therapy—including isavuconazole, liposomal amphotericin B, piperacillin-tazobactam, and mechanical support strategies (e.g., extracorporeal membrane oxygenation [ECMO], continuous renal replacement therapy [CRRT])—infection control was difficult. The patient eventually recovered partial consciousness and was discharged for rehabilitation. Discussion Invasive fungal infections, particularly those caused by A. terreus , present diagnostic and therapeutic challenges in critically ill patients. Early molecular identification and tailored antifungal therapy based on pathogen resistance profiles are essential. Moreover, recognizing and managing bacterial and viral coinfections are vital for optimizing patient outcomes. Conclusion This case highlights the necessity of prompt, multimodal diagnostic approaches and individualized antifungal and antibacterial therapy in the management of ICU-acquired infections post-myocardial infarction.
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Yu et al. (2025) conducted a case report in Aspergillus terreus and Klebsiella pneumoniae coinfection following acute myocardial infarction (n=1). Antimicrobial therapy and mechanical support was evaluated on Clinical recovery. Aggressive antimicrobial therapy and mechanical support enabled partial recovery and discharge for rehabilitation in a 53-year-old male with A. terreus and K. pneumoniae coinfection post-MI.
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