RESUMO
We report the presentation and management of 17 cases of Exophiala dermatitidis and Rhodotorula mucilaginosa bloodstream infections caused by a compounded parenteral medication at an oncology clinic. Twelve patients were asymptomatic. All central venous catheters were removed and antifungal therapy, primarily voriconazole, was administered to patients. Three patients died.
Assuntos
Gerenciamento Clínico , Surtos de Doenças , Contaminação de Medicamentos , Fungemia/tratamento farmacológico , Feoifomicose/tratamento farmacológico , Idoso , Instituições de Assistência Ambulatorial , Antifúngicos/uso terapêutico , Infecções Assintomáticas , Exophiala/efeitos dos fármacos , Exophiala/isolamento & purificação , Feminino , Fungemia/mortalidade , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Serviço Hospitalar de Oncologia , Pacientes Ambulatoriais , Feoifomicose/mortalidade , Rhodotorula/efeitos dos fármacos , Rhodotorula/isolamento & purificaçãoRESUMO
Transplant recipients are at a high risk for developing invasive fungal infections. The agents of phaeohyphomycosis are environmental molds found worldwide, and they cause a broad spectrum of disease including skin and subcutaneous lesions, pneumonia, central nervous system disease, fungemia, and disseminated disease. Using data from the Transplant Associated Infection Surveillance Network (TRANSNET), we evaluated patients with proven and probable phaeohyphomycosis. Centers collected data on demographics, co-morbid conditions, clinical features, treatment, and three-month mortality. Fifty-six patients with phaeohyphomycosis were identified from 15 centers, comprising 26 stem cell transplant (SCT) and 30 solid organ transplant (SOT) recipients. Median time to diagnosis post-transplant was 358 days (SCT 100 days; SOT 685 days; P = <.001). The most frequent pathogen was Alternaria species (32%). Disseminated disease was found in 55.4%. Cutaneous infection was more common in SOT (53.3% vs 23.1%; P = .021), while pulmonary disease was more common in SCT (57.7 vs. 26.7; P = .019). Voriconazole (44.6%) and amphotericin B preparations (37.5%) were the most common antifungal therapies. Overall mortality was 25% and was higher in SCT than in SOT (42% vs 10%; P = <.001). A wide variety of organisms encompass phaeohyphomycosis contributing to varying types of infection in transplant recipients. Site of infection, time to disease, and mortality varies significantly between SCT and SOT recipients. Lipid formulations of amphotericin B and voriconazole were the most common antifungals used to treat this disorder.
