Background
The incidence of hospital-acquired fungaemia caused by yeasts has increased dramatically during the past two decades. This increased incidence has been associated with advances in clinical medicine, including organ transplantation, chemotherapy, antimicrobial agents, parenteral nutrition, and medical devices, all of which improve patient survival but increase the risk of infection.Candida species are the leading cause of yeast fungaemia. However, as the fungaemia patient population has changed, several types of rare yeasts have become recognised pathogens, particularly in nosocomial settings, and have increased in clinical importance. These yeasts, which include Trichosporon species, Cryptococcus species, Rhodotorula species, Malassezia species, and Blastoschizomyces capitatus, have been associated with life-threatening infections in immunocompromised patients.
The mortality rate among patients with fungaemia is high, ranging from 50% to 80%. The variable susceptibility profiles to antifungal agents are one of the major reasons for the poor prognosis of these yeast infections. Candida species are usually susceptible to standard antifungal agents. However, the treatment of non-Candida yeasts is challenging because of their rarity and the prevalence of in vitro resistance to standard antifungal agents. For example, Cryptococcus species are resistant to echinocandins, and Trichosporon species are characterised by resistance to amphotericin and echinocandins. For these reasons, early distinction between non-Candida species and Candida species is important.
Although the importance of non-Candida yeasts is recognised, little is known about the epidemiology and risk factors associated with non-Candida fungaemia. To evaluate the clinical characteristics of non-Candida fungaemia and determine the risk factors associated with non-Candida fungaemia, we conducted a retrospective cohort study of yeast fungaemia detected in a tertiary-care university hospital over a 6-year period.