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

Summary 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 descr...

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Bibliographic Details
Published in:Mycoses 2020-05, Vol.63 (5), p.488-493
Main Authors: Alp, Sehnaz, Gulmez, Dolunay, Ayaz, Caglayan Merve, Arikan‐Akdagli, Sevtap, Akova, Murat
Format: Article
Language:English
Subjects:
Amphotericin B
Antifungal agents
antifungal resistance
antifungal treatment
azoles
breakthrough fungaemia
Echinocandins
Fluconazole
fungaemia
Health risk assessment
Itraconazole
Malignancy
Patients
Posaconazole
rare yeast
Voriconazole
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Summary:Summary 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 
ISSN:0933-7407
1439-0507
DOI:10.1111/myc.13072