Fungemia due to Rare Yeasts Other Than Candida: 10 Years of Single-center Experience Candida Dışında Görülen Mayalarla Gelişen Fungemiler: 10 Yıllık Tek Merkez Deneyimi


TEPE D., AKSOY F., YILMAZ G., TOSUN İ., ÖZKAYA E., KAYA S.

Mediterranean Journal of Infection, Microbes and Antimicrobials, vol.12, 2023 (ESCI) identifier identifier

Abstract

Introduction: Fungemia due to rare yeasts other than Candida (RYOC) has been increasingly reported; however, data on the management of patients are limited. This study aimed to determine antifungal susceptibility profiles of the isolates and clinical characteristics, management, and outcomes of patients with fungemia due to RYOC in a tertiary-care university hospital. Materials and Methods: Between January 2013 and January 2022, cases of fungemia caused by RYOC were retrospectively examined. Antifungal susceptibility tests were performed according to the Clinical and Laboratory Standards Institute M27-A3. Results: The incidence of RYOC was %4,9 (n=31) among 637 fungemia episodes. The most common isolated fungi were Trichosporon asahii (n=11). An antifungal susceptibility test could be performed on 25/31 strains. Azole minimum inhibitory concentration (MIC) values were low for T. asahii and T. coremiiforme. Amphotericin-B and voriconazole (VRC) MICs were low for Saprochaete clavata isolates, whereas those of fluconazole (FLC) and echinocandin were high. The most commonly preferred empirical antifungal was liposomal amphotericin-B (n=7) followed by VRC (n=4) and FLC (n=2). Of the 13 patients who received appropriate treatment either started empirically or after identification, 10 survived (p=0.01). The overall mortality rate was 53% (n=16). The mortality rate of patients with hematologic malignancy was significantly higher than that other patients with risk factors (p=0.01). Of the patients in whom appropriate treatment was initiated, three died because the foci of infection could not be controlled. Conclusion: Maintaining high clinical suspicion of RYOC is crucial in empirical treatment. Early detection of species and determining antifungal susceptibility patterns of RYOC will guide clinicians in the treatment of these yeasts.