Fungaemia due to rare yeasts in a tertiary care university centre within 18 years

Abstract

Background: Fungaemia due to rare yeasts has been recognised as an emerging, clinically relevant, but less investigated condition. Intrinsic resistance or reduced susceptibility of these species to echinocandins or fluconazole remains as a challenge in empirical treatment. Objectives:To describe the clinical characteristics, administered antifungal agents, outcomes of patients with rare yeasts other than Candida (RY-OTC) fungaemia and determine the antifungal susceptibility profiles of the isolates. Patients and methods: RY-OTC fungaemia between January-2001 andDecember-2018 were retrospectively evaluated. Antifungal susceptibility tests were performed according to CLSI M27-A3. Results:We identified 19 patients with fungaemia due to 20 RY-OTC (8 Trichosporon asahii, 4 Cryptococcus neoformans, 4 Saprochaete capitata, 3 Rhodotorula mucilaginosa, 1 Trichosporon mucoides) with an incidence of 2.2% among 859 fungaemia episodes.Haematological malignancy was the most common (42%) underlying disorder. In 6 patients, RY-OTC fungaemia developed as breakthrough infection while receiving echinocandins, amphotericin B or fluconazole. Amphotericin B, fluconazole or voriconazole were the drugs of choice for the initial treatment of breakthrough fungaemia. Among patients without previous exposure to antifungals, the most common empirical treatment was an echinocandin (50%), followed by fluconazole (42%) and amphotericin B (8%). Overall mortality was 47%. Worse outcome was most common among patients receiving echinocandins (83% vs 25%, P < .05). Voriconazole and posaconazole showed the highest in vitro activity against all the isolates tested. Amphotericin B MICs were relatively higher and the degree of activity of fluconazole and itraconazole was variable. Conclusions: Early recognition of RY-OTC and knowledge about their susceptibility patterns remain crucial in initial treatment pending susceptibility data of isolates. K E Y W O R D S amphotericin B, antifungal resistance, antifungal treatment, azoles, breakthrough fungaemia, echinocandins, fungaemia, rare yeast | 489 ALP et AL.

Epidemiology of Candidemia in Kuwait: A Nationwide, Population-Based Study

“…An overall mortality rate of 71% was seen among patients infected with rare yeast species. Our data are consistent with recent reports showing that fungemia due to rare yeast pathogens in both pediatric and adult patients is usually associated with mortality rates higher than those seen with common Candida species, particularly among patients receiving echinocandin therapy [ 82 , 87 , 88 ].…”

Distribution of Yeast Species and Risk Factors of Oral Colonization after Oral-Care Education among the Residents of Nursing Homes

“…There were seven residents colonized by C. pararugosa , which was first reported in 2017 to cause bloodstream infections [ 27 ]. Hence, it is worth noting that in addition to those common species that cause diseases in humans, some rare species that were recovered in the present study such as Candida norvegensis [ 28 ], C. utilis [ 29 ], Cystobasidium minutum ( Rhodotorula minute ) [ 30 ], Exophiala dermatitidis [ 31 , 32 , 33 ], Lodderomyces elongisporus [ 34 , 35 ], Magnusiomyces capitatus [ 36 ], and Trichosporon mucoides [ 37 ] have been reported to cause invasive infections in humans.…”

Trichosporon asahii and Trichosporon inkin Biofilms Produce Antifungal-Tolerant Persister Cells

“…are ubiquitous fungi, commonly found as commensals of the human skin and gastrointestinal tract (Duarte-Oliveira et al, 2017). Trichosporon species are emerging opportunistic fungi that have been increasingly reported as agents of fungemia in the last years, especially in immunocompromised patients (Challapilla et al, 2019;Sah et al, 2019;Alp et al, 2020). Furthermore, Trichosporon species have been reported as the second leading cause of invasive yeast infection in patients with malignant hematological diseases (Almeida and Hennequin, 2016).…”