Increased incidence, risk factors, and outcomes of Trichosporon spp bloodstream infections in immunocompromised hosts

Abstract

Objectives: To evaluate the incidence, risk factors, patient characteristics, and outcomes Trichosporon spp bloodstream infections in immunocompromised patients. Methods: This was a single centre retrospective study. Patients older than 18 years of age with Trichosporon spp bloodstream infections from 2004 to 2017 were reviewed. Data were extracted from the electronic medical records and the microbiology database and then analyzed. Results: Eight patients with Trichosporon spp bloodstream infections were included; 7 had hematological malignancies and 1 had ulcerative colitis but had undergone immunosuppressive therapy. A mean of 0.41 episodes per year were noted, but in 2017, 3 episodes were observed – more than a sevenfold increase over the mean. T. asahii was the most common isolate, seen in 7/9 isolates in 8 patients. Three episodes were labelled as primary fungemia (37.5%) and five (62.5%) were line-related. Previous use of steroids, broad-spectrum antibiotics, and neutropenia were found to be common co-existent factors in our patients. The mean treatment duration was 22.9 days and the response rate was 50% with a 30-day mortality rate of 50%. Conclusions: We observed a sixfold increase in the incidence of Trichosporon spp bloodstream infection in the final year of our study. These patients were predisposed to this infection due to their immunosuppressed state. Concerns about Trichosporon fungemia in such patients may impact the choice of antifungal therapy.