João Nobrega de Almeida1,2, Elaine Cristina Francisco3, Alexis Holguín Ruiz4, Luis E Cuéllar4, Valério Rodrigues Aquino5, Ana Verena Mendes6, Flávio Queiroz-Telles7, Daniel Wagner Santos3, Thais Guimarães8, Guilherme Maranhão Chaves9, Bianca Grassi de Miranda10, Fabio Araújo Motta11, Alexandre Vargas Schwarzbold12, Márcio Oliveira6, Fernando Riera13, Jamile Sardi Perozin14, Rejane Pereira Neves15, Ivan Leonardo A França E Silva16, Jaques Sztajnbok17, Jéssica Fernandes Ramos18,19, Monica Borges Botura20, Fabianne Carlesse21,22, Paulo de Tarso de O E Castro23, Themba Nyirenda24, Arnaldo L Colombo3. 1. Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA. 2. Central Laboratory Division-LIM03, Hospital das Clínicas da FMUSP, São Paulo, Brazil. 3. Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil. 4. Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru. 5. Hospital de Clínicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. 6. Hospital São Rafael, Salvador, Brazil. 7. Hospital de Clínicas, Infectious Diseases Department, Universidade Federal do Paraná, Curitiba, Brazil. 8. Hospital do Servidor Público Estadual, São Paulo, Brazil. 9. Laboratory of Medical and Molecular Mycology, Department of Clinical and Toxicological Analyses, Universidade Federal do Rio Grande do Norte, Natal, Brazil. 10. Hospital Samaritano, São Paulo, Brazil. 11. Hospital Pequeno Príncipe, Curitiba, Brazil. 12. Internal Medicine Department, Universidade Federal de Santa Maria, Santa Maria, Brazil. 13. Sanatório Allende Córdoba, Córdoba, Argentina. 14. Hospital do Câncer de Londrina, Londrina, Brazil. 15. Universidade Federal de Pernambuco, Recife, Brazil. 16. A.C. Camargo Cancer Center, São Paulo, Brazil. 17. Instituto da Criança, Hospital das Clínicas da FMUSP, São Paulo, Brazil. 18. Hospital Sírio Libanês, São Paulo, Brazil. 19. Infectious Diseases Department, Hospital de Clínicas, Hospital das Clínicas da FMUSP, São Paulo, Brazil. 20. Hospital de Clínicas, Universidade Federal da Bahia. 21. Departamento de Pediatria, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, Brazil. 22. Instituto de Oncologia Pediátrica-IOP-GRAACC-UNIFESP, São Paulo, Brazil. 23. Hospital de Câncer de Barretos, Barretos, São Paulo, SP, Brazil. 24. Hackensack Meridian Health, Nutley, NJ, USA.
Abstract
BACKGROUND: Trichosporon fungaemia (TF) episodes have increased in recent years and mortality rates remain high despite the advances in the management of sepsis. New concepts about its clinical course, treatment and microbiology need to be investigated for the better management of this infection. OBJECTIVES: To describe the aetiology, natural history, clinical management and prognostic factors of TF. METHODS: TF episodes documented between 2005 and 2018 in 23 South American centres were retrospectively investigated by using a standard clinical form. Molecular identification, antifungal susceptibility testing and biofilm production were also performed. RESULTS: Eighty-eight TF episodes were studied. Patients had several underlying conditions, including haematological diseases (47.7%), post-operative status (34%), solid organ transplants (n = 7, 7.9%), among others. Seventy-three (82.9%) patients had a central venous catheter (CVC) at TF diagnosis. The 30 day mortality rate was 51.1%. Voriconazole-based therapy was given to 34 patients (38.6%), with a 30 day mortality rate of 38.2%. Multivariate predictors of 30 day mortality were age (OR 1.036), mechanical ventilation (OR 8.25) and persistent neutropenia (OR 9.299). CVC removal was associated with over 75% decreased risk of 30 day mortality (OR 0.241). Microbiological analyses revealed that 77.7% of the strains were identified as Trichosporon asahii, and voriconazole showed the strongest in vitro activity against Trichosporon spp. Most of the strains (63%) were considered medium or high biofilm producers. CONCLUSIONS: Older age, mechanical ventilation and persistent neutropenia were associated with poor prognosis. CVC may play a role in the pathogenicity of TF and its removal was associated with a better prognosis.
BACKGROUND:Trichosporon fungaemia (TF) episodes have increased in recent years and mortality rates remain high despite the advances in the management of sepsis. New concepts about its clinical course, treatment and microbiology need to be investigated for the better management of this infection. OBJECTIVES: To describe the aetiology, natural history, clinical management and prognostic factors of TF. METHODS: TF episodes documented between 2005 and 2018 in 23 South American centres were retrospectively investigated by using a standard clinical form. Molecular identification, antifungal susceptibility testing and biofilm production were also performed. RESULTS: Eighty-eight TF episodes were studied. Patients had several underlying conditions, including haematological diseases (47.7%), post-operative status (34%), solid organ transplants (n = 7, 7.9%), among others. Seventy-three (82.9%) patients had a central venous catheter (CVC) at TF diagnosis. The 30 day mortality rate was 51.1%. Voriconazole-based therapy was given to 34 patients (38.6%), with a 30 day mortality rate of 38.2%. Multivariate predictors of 30 day mortality were age (OR 1.036), mechanical ventilation (OR 8.25) and persistent neutropenia (OR 9.299). CVC removal was associated with over 75% decreased risk of 30 day mortality (OR 0.241). Microbiological analyses revealed that 77.7% of the strains were identified as Trichosporon asahii, and voriconazole showed the strongest in vitro activity against Trichosporon spp. Most of the strains (63%) were considered medium or high biofilm producers. CONCLUSIONS: Older age, mechanical ventilation and persistent neutropenia were associated with poor prognosis. CVC may play a role in the pathogenicity of TF and its removal was associated with a better prognosis.