Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
J Formos Med Assoc. 2021 Sep;120(9):1686-1694. doi: 10.1016/j.jfma.2020.12.007. Epub 2020 Dec 24.
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.
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.
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.
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.
背景/目的：侵袭性毛孢子菌感染正在出现，但不同毛孢子菌菌血症治疗管理与临床结果的关联很少有报道。本研究调查了台湾的毛孢子菌病的流行病学、种属分布和基因型，并确定了毛孢子菌菌血症患者临床结果的预测因素。
从台湾的四个医疗中心收集 2010-2018 年期间的菌株。通过 IGS1 区域测序确认种属鉴定，使用 Sensititre YeastOne 试剂盒进行抗真菌药敏试验。
在 115 株分离株中，近平滑毛孢子菌占主导地位（73.0%），其次是糠秕马拉色菌（11.3%）、粪生毛孢子菌（6.1%）和蒙特维地毛孢子菌（5.2%）。84 株近平滑毛孢子菌分离株中，基因型 1 是主要型（41.7%）。70.2%的近平滑毛孢子菌分离株和 16.1%的非近平滑毛孢子菌毛孢子菌分离株对氟康唑最小抑菌浓度（MIC，≧8μg/mL）较高。泊沙康唑和伏立康唑对所有毛孢子菌分离株具有最强的抗真菌活性，几何平均值分别为 0.251μg/mL 和 0.111μg/mL。从血液培养中分离出 53 株和 42 例菌血症患者，进行 Kaplan-Meier 图分析，结果显示伏立康唑治疗组的生存率明显高于未治疗组（p=0.042）。多因素分析显示，源头控制（比值比[OR]：0.13 95%置信区间[CI]：0.02-0.83，p=0.031）和伏立康唑使用（OR：0.11 95%CI：0.02-0.74，p=0.023）是 14 天死亡率的独立预测因素。
这是迄今为止最大的毛孢子菌菌血症系列研究。伏立康唑治疗和源头控制在 14 天死亡率中起着重要作用。
