title: Emerging pan-resistance in Trichosporon species: a case report.
abstract: BACKGROUND
  Trichosporon species are ubiquitously spread and known to be part of the normal human flora of the skin and gastrointestinal tract. Trichosporon spp. normally cause superficial infections. However, in the past decade Trichosporon spp. are emerging as opportunistic agents of invasive fungal infections, particularly in severely immunocompromised patients. Clinical isolates are usually sensitive to triazoles, but strains resistant to multiple triazoles have been reported.
  
  
  METHODS
  We report a high-level pan-azole resistant Trichosporon dermatis isolate causing an invasive cholangitis in a patient after liver re-transplantation. This infection occurred despite of fluconazole and low dose amphotericin B prophylaxis, and treatment with combined liposomal amphotericin B and voriconazole failed.
  
  
  CONCLUSIONS
  This case and recent reports in literature show that not only bacteria are evolving towards pan-resistance, but also pathogenic yeasts. Prudent use of antifungals is important to withstand emerging antifungal resistance.
authors.affiliation: Department of Medical Microbiology (EB 80), University Medical Center Groningen, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands. c.oliveira.dos.santos@umcg.nl.
authors.forename: Claudy
authors.initials: C
authors.lastname: Oliveira dos Santos
authors.affiliation: Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Jan G
authors.initials: JG
authors.lastname: Zijlstra
authors.affiliation: Department of Hepatobiliary Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Porte
authors.affiliation: Department of Medical Microbiology (EB 80), University Medical Center Groningen, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands.
authors.forename: Greetje A
authors.initials: GA
authors.lastname: Kampinga
authors.affiliation: CBS-KNAW Fungal Biodiversity Center, Utrecht, The Netherlands.
authors.forename: Anne D
authors.initials: AD
authors.lastname: van Diepeningen
authors.affiliation: Department of Medical Microbiology (EB 80), University Medical Center Groningen, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands.
authors.forename: Bhanu
authors.initials: B
authors.lastname: Sinha
authors.affiliation: Department of Medical Microbiology (EB 80), University Medical Center Groningen, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Bathoorn
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002761:Cholangitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D025141:Drug Resistance, Fungal; D006501:Hepatic Encephalopathy / Q000175:diagnosis; D006801:Humans; D008103:Liver Cirrhosis / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis; D010802:Phylogeny; D014250:Trichosporon / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D060586:Trichosporonosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B; D065819:Voriconazole
keywords: Antifungal stewardship; Disseminated trichosporonosis; Invasive fungal disease; Liver transplant; Trichosporon dermatis