关键词: Antifungal stewardship Disseminated trichosporonosis Invasive fungal disease Liver transplant Trichosporon dermatis

Mesh : Amphotericin B / therapeutic use Antifungal Agents / therapeutic use Cholangitis / diagnosis drug therapy microbiology Drug Resistance, Fungal Hepatic Encephalopathy / diagnosis Humans Liver Cirrhosis / therapy Liver Transplantation Male Microbial Sensitivity Tests Middle Aged Peritonitis / diagnosis Phylogeny Trichosporon / classification drug effects isolation & purification Trichosporonosis / diagnosis drug therapy microbiology Voriconazole / therapeutic use

来  源:   DOI:10.1186/s12879-016-1477-3   PDF(Sci-hub)

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.
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