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. 2020 May;63(5):488-493.
doi: 10.1111/myc.13072. Epub 2020 Mar 20.

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

Sehnaz Alp  1 , Dolunay Gulmez  2 , Caglayan Merve Ayaz  1 , Sevtap Arikan-Akdagli  2 , Murat Akova  1
Affiliations

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

Sehnaz Alp et al. Mycoses. 2020 May.

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 and December-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.

Keywords: amphotericin B; antifungal resistance; antifungal treatment; azoles; breakthrough fungaemia; echinocandins; fungaemia; rare yeast.

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References

REFERENCES

    1. Miceli MH, Diaz JA, Lee SA. Emerging opportunistic yeast infections. Lancet Infect Dis. 2011;11:142-151.
    1. Caira M, Trecarichi EM, Tumbarello M, Leone G, Pagano L. Uncommon yeast infections in hematological patients: from diagnosis to treatment. Expert Rev Anti Infect Ther. 2011;9:1067-1075.
    1. Chang A, Neofytos D, Horn D. Candidaemia in the 21st century. Future Microbiol. 2008;3:463-472.
    1. Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev. 2007;20:133-163.
    1. Yamamoto M, Takakura S, Hotta G, et al. Clinical characteristics and risk factors of non-Candida fungaemia. BMC Infect Dis. 2013;13:247.

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