The epidemiology, genotypes, antifungal susceptibility of Trichosporon species, and the impact of voriconazole on Trichosporon fungemia patients
Journal
Journal of the Formosan Medical Association
Journal Volume
120
Journal Issue
9
Pages
1686-1694
Date Issued
2021
Author(s)
Abstract
Background/purpose: Invasive Trichosporon infections are emerging, but association of different therapeutic management of Trichosporon fungemia and clinical outcomes were rarely reported. This study investigates the epidemiology, species distribution and genotypes of trichosporonosis in Taiwan, and identified the predictors of clinical outcomes in patients with Trichosporon fungemia. Methods: Strains collected from four medical centers in Taiwan, during 2010–2018. Species identification was confirmed by sequencing of IGS1 region, and antifungal susceptibility was performed using Sensititre YeastOne panel. Results: Among 115 isolates, Trichosporon asahii was the leading species (73.0%), followed by Trichosporon dermatis (11.3%), Trichosporon faecales (6.1%), and Trichosporon montevideense (5.2%). Of the 84 T. asahii isolates, genotype 1 was the predominant (41.7%). High fluconazole minimal inhibitory concentration (MICs,≧8 μg/mL) were observed for 70.2% T. asahii isolates and 16.1% non-asahii Trichosporon isolates. Posaconazole and voriconazole possess the most potent antifungal activity against all Trichosporon isolates, with geometric mean values of 0.251 μg/mL and 0.111 μg/mL, respectively. Fifty-three isolates collected from blood cultures, and 42 patients with fungemia enrolled for the Kaplan–Meier plot which revealed that voriconazole treatment had a significantly better survival rate compared with those without (p = 0.042). In multivariate analysis, source control (odds ratio [OR]: 0.13 95%CI [confidence interval]: 0.02–0.83, p = 0.031) and voriconazole use (OR: 0.11 95%CI: 0.02–0.74, p = 0.023) are independent predictors of 14-day mortality. Conclusion: This is the largest series of Trichosporon fungemia up till the present moment. Voriconazole therapy and source control play important roles in 14-day mortality. ? 2020
Subjects
Antifungal susceptibility; Fungemia; Trichosporon; Trichosporon asahii; Voriconazole
SDGs
Other Subjects
amphotericin B; anidulafungin; caspofungin; fluconazole; flucytosine; itraconazole; micafungin; posaconazole; ribosome DNA; voriconazole; antifungal agent; fungal DNA; voriconazole; abscess; adult; antifungal susceptibility; Article; bacterial strain; bacterium isolate; bloodstream infection; body fluid; Candida albicans; catheter infection; Charlson Comorbidity Index; chronic kidney failure; clinical article; clinical outcome; comorbidity; controlled study; drug potency; female; fungemia; genotype; hematologic malignancy; human; male; malignant neoplasm; middle aged; minimum inhibitory concentration; mortality; multicenter study; pathogenesis; respiratory tract secretion; retrospective study; Sanger sequencing; secretion (process); septic shock; Sequential Organ Failure Assessment Score; solid malignant neoplasm; species distribution; species identification; strain identification; superficial abscess; survival rate; Taiwan; Trichosporon; Trichosporon asahii; Trichosporon dermatis; Trichosporon faecales; Trichosporon montevideense; trichosporonosis; Basidiomycetes; fungemia; genetics; genotype; microbial sensitivity test; Antifungal Agents; Basidiomycota; DNA, Fungal; Fungemia; Genotype; Humans; Microbial Sensitivity Tests; Trichosporon; Voriconazole
Publisher
Elsevier B.V.
Type
journal article