Epidemiology, clinical aspects, outcomes and prognostic factors associated with Trichosporon fungaemia: results of an international multicentre study carried out at 23 medical centres

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de Almeida Jr, Joao Nobrega ; Francisco, Elaine Cristina ^[1] ; Ruiz, Alexis Holguin ^[2] ; Cuellar, Luis E. ^[2] ; Aquino, Valerio Rodrigues ^[3] ; Mendes, Ana Verena ^[4] ; Queiroz-Telles, Flavio ^[5] ; Santos, Daniel Wagner ^[1] ; Guimaraes, Thais ^[6] ; Chaves, Guilherme Maranhao ^[7] ; de Miranda, Bianca Grassi ^[8] ; Motta, Fabio Araujo ^[9] ; Schwarzbold, Alexandre Vargas ^[10] ; Oliveira, Marcio ^[4] ; Riera, Fernando ^[11] ; Sardi Perozin, Jamile ^[12] ; Neves, Rejane Pereira ^[13] ; Silva, Ivan Leonardo A. Franca E. ^[14] ; Sztajnbok, Jaques ^[15] ; Ramos, Jessica Fernandes ^{[16, 17]} ; Borges Botura, Monica ^[18] ; Carlesse, Fabianne ^{[19, 20]} ; Castro, Paulo de Tarso de O. E. ^[21] ; Nyirenda, Themba ^[22] ; Colombo, Arnaldo L. ^[1]

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^[1] Univ Fed Sao Paulo, Div Infect Dis, Escola Paulista Med, Sao Paulo - Brazil

^[2] Inst Nacl Enfermedades Neoplas, Lima - Peru

^[3] Univ Fed Rio Grande do Sul, Hosp Clin, Porto Alegre, RS - Brazil

^[4] Hosp Sao Rafael, Salvador, BA - Brazil

^[5] Univ Fed Parana, Hosp Clin, Infect Dis Dept, Curitiba, Parana - Brazil

^[6] Hosp Servidor Publ Estadual, Sao Paulo - Brazil

^[7] Univ Fed Rio Grande do Norte, Dept Clin & Toxicol Anal, Lab Med & Mol Mycol, Natal, RN - Brazil

^[8] Hosp Samaritano, Sao Paulo - Brazil

^[9] Hosp Pequeno Principe, Curitiba, Parana - Brazil

^[10] Univ Fed Santa Maria, Internal Med Dept, Santa Maria, RS - Brazil

^[11] Sanatorio Allende Cordoba, Cordoba - Argentina

^[12] Hosp Canc Londrina, Londrina, Parana - Brazil

^[13] Univ Fed Pernambuco, Recife, PE - Brazil

^[14] AC Camargo Canc Ctr, Sao Paulo - Brazil

^[15] FMUSP, Inst Crianca, Hosp Clin, Sao Paulo - Brazil

^[16] Hosp Sirio Libanes, Sao Paulo - Brazil

^[17] FMUSP, Hosp Clin, Infect Dis Dept, Sao Paulo - Brazil

^[18] Univ Fed Bahia, Hosp Clin, Sao Paulo - Brazil

^[19] Univ Fed Sao Paulo, Dept Pediat, Escola Paulista Med, Sao Paulo - Brazil

^[20] Inst Oncol Pediat IOP GRAACC UNIFESP, Sao Paulo - Brazil

^[21] Hosp Canc Barretos, Sao Paulo, SP - Brazil

^[22] Hackensack Meridian Hlth, Nutley, NJ - USA

• Tipo de documento: Artigo Científico
• Fonte: Journal of Antimicrobial Chemotherapy; v. 76, n. 7, p. 1907-1915, JUL 2021.
• Citações Web of Science: 0

Resumo

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. (AU)

• Processo FAPESP: 18/19347-4 - Caracterização de mecanismos moleculares associados à resistência aos derivados azólicos em cepas clínicas de Trichosporon asahii
• Beneficiário: João Nóbrega de Almeida Júnior
• Modalidade de apoio: Bolsas no Exterior - Pesquisa