title: Rare opportunistic (non-Candida, non-Cryptococcus) yeast bloodstream infections in patients with cancer.
abstract: BACKGROUND
  Rare opportunistic (non-Candida, non-Cryptococcus) yeast bloodstream infections (ROYBSIs) are rare, even in cancer patients.
  
  
  METHODS
  We retrospectively reviewed all episodes of ROYBSIs occurring from 1998 to 2010 in our cancer center.
  
  
  RESULTS
  Of 2984 blood cultures positive for Candida and non-Candida yeasts, 94 (3.1%) were positive for non-Candida yeasts, representing 41 ROYBSIs (incidence, 2.1 cases/100,000 patient-days). Catheter-associated fungemia occurred in 21 (51%) patients. Breakthrough ROYBSIs occurred in 20 (49%) patients. The yeast species distribution was Rhodotorula in 21 (51%) patients, Trichosporon in 8 (20%) patients, Saccharomyces cerevisiae in 8 (20%) patients, Geotrichum in 2 (5%) patients, Pichia anomala, and Malassezia furfur in 1 patient each. All tested Trichosporon, Geotrichum, and Pichia isolates were azole-susceptible, whereas the Rhodotorula isolates were mostly azole-resistant. We noted echinocandin nonsusceptibility (minimal inhibitory concentration ≥ 2 mg/L) in all but the S. cerevisiae isolates. Most of the isolates (28/33 [85%]) were susceptible to amphotericin B. The mortality rate in all patients at 30 days after ROYBSIs diagnosis was 34%. Multivariate survival analysis revealed increased risk of death in patients with S. cerevisiae infections (hazard ratio, 3.7), Geotrichum infections (hazard ratio, 111.3), or disseminated infections (hazard ratio, 33.4) and reduced risk in patients who had catheter removal (hazard ratio, 0.1).
  
  
  CONCLUSIONS
  ROYBSIs are uncommon in patients with cancer, and catheters are common sources of them. Half of the ROYBSIs occurred as breakthrough infections, and in vitro species-specific resistance to echinocandins and azoles was common. Disseminated infections resulted in the high mortality rate.
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Maria N
authors.initials: MN
authors.lastname: Chitasombat
authors.forename: Diamantis P
authors.initials: DP
authors.lastname: Kofteridis
authors.forename: Ying
authors.initials: Y
authors.lastname: Jiang
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tarrand
authors.forename: Russell E
authors.initials: RE
authors.lastname: Lewis
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage / Q000494:pharmacology; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D002648:Child; D025141:Drug Resistance, Fungal; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009894:Opportunistic Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D015003:Yeasts / Q000145:classification* / Q000187:drug effects / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
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