P294 A descriptive study of Trichosporon fungemia cases from tertiary care center from north India

Abstract

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectiveIncidence of fungaemia with Trichosporon spp is increasing especially in immunocompromised patients. High mortality of 60% is associated with T. fungemia. Trichosporon species are intrinsically resistant to echinocandins, exhibit high MICs to amphotericin B, and have a propensity to form biofilm necessitating accurate and timely diagnosis. Cases of Trichosporon fungemia are often misdiagnosed and under-reported owing to the difficulties in diagnosis. Here, we report the clinical presentation and outcome of Trichosporon fungemia cases at the tertiary care center from north India.MethodsThis is a descriptive study conducted at the Department of Medical Microbiology, PGIMER, Chandigarh, India. A total of 8 patients who had fungemia due to Trichosporon spp. were included in the study. Trichosporon spp. was identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) with an updated database. Antifungal susceptibility was done using microbroth dilution method recommended by the Clinical and Laboratory Standards Institute (CLSI). Beta-D-glucan (BDG) assay was performed as per the manufacturer's recommendation. Demographic and clinical data along with treatment outcomes of all the patients were noted from medical records.ResultsThe average age of presentation of patients diagnosed with Trichosporon fungemia was 44 years and the male to female ratio was 5:3. The underlying conditions included necrotizing pancreatitis (n = 2), infective endocarditis (n = 2) and renal transplant (n = 1) The other risk factors included the use of broad-spectrum antibiotics (n = 7), a central venous catheter (n = 4), and prior surgical procedures (n = 3) BDG was tested in 5 patients and 4 patients had a positive value of >80 pg/ml. A total of 5/8 patients received antifungal treatment. Six patients clinically improved and were discharged while two patients died of refractory shock despite treatment with amphotericin B. Minimum inhibitory concentration of Trichosporon isolates was (range): amphotericin B 0.5-16 μg/ml, fluconazole 0.12-32 μg/ml, voriconazole 0.03-1 μg/ml, itraconazole 0.03-1 μg/ml, and posaconazole 0.03-0.5 μg/ml.Conclusion Trichosporon spp. is an opportunistic pathogen causing fungemia in immunocompromised patients. Most of the patients in our study were immunocompetent except for one post-transplant patient. BDG helps in the diagnosis of this infection. This study highlights the need to accurately diagnose Trichosporon infections and perform antifungal susceptibility testing for guiding appropriate management and reducing mortality.