Rhodotorula infection in haematological patient: Risk factors and outcome

Leonardo Potenza, Maria N. Chitasombat, Nikolay Klimko, Francesca Bettelli, Giulia Dragonetti, Maria Ilaria Del Principe, Marcio Nucci, Alessandro Busca, Nicola Fracchiolla, Mariarita Sciumè, Angelica Spolzino, Mario Delia, Valentina Mancini, Gian Paolo Nadali, Michela Dargenio, Olga Shadrivova, Federico Bacchelli, Franco Aversa, Maurizio Sanguinetti, Mario LuppiDimitrios P. Kontoyiannis, Livio Pagano

Research output: Contribution to journalArticle

Abstract

Background: Rhodotorula spp are uncommon yeasts able to cause infections with high mortality rates. Rhodotorula infections have been associated with the presence of central venous catheter (CVC), immunosuppression, exposure to antifungals and the presence of either solid or haematologic malignancies. However, in this latter setting, only a few cases have so far been reported. Objectives: We have conducted a survey for Rhodotorula infections in haematologic patients. Methods: Patients’ clinical and microbiological data were collected and correlated to the outcome. Results: A total of 27 cases were detected from 13 tertiary care hospitals. About 78% and 89% of patients had acute leukaemia and CVC. About 70% of patients were exposed to prophylaxis with azoles, mainly posaconazole (37%), 59% were severely neutropenic and 37% underwent allogeneic stem cell transplantation (alloSCT). The most frequent treatments were liposomal amphotericin B (L-AmB) and CVC removal in 17 and 16 patients, respectively. One month post-diagnosis, mortality was 26% and was associated with the presence of mucositis (P = 0.034). Conclusions: Our study shows that Rhodotorula spp should be considered as aetiologic agents of breakthrough infections in acute leukaemia patients with a CVC, mucositis, who receive prophylaxis with azoles, including posaconazole, and/or undergo alloSCT. Prompt measures, such as L-AmB administration and CVC removal, should be carried out to avoid the high mortality risk of Rhodotorula infections.

Original languageEnglish
Pages (from-to)223-229
JournalMycoses
Volume62
Issue number3
DOIs
Publication statusPublished - 2019

Fingerprint

Rhodotorula
Central Venous Catheters
Infection
Azoles
Mucositis
Stem Cell Transplantation
Mortality
Leukemia
Hematologic Neoplasms
Tertiary Healthcare
Tertiary Care Centers
Immunosuppression
Yeasts

Keywords

  • haematologic cancer
  • infections
  • opportunistic
  • Rhodotorula
  • yeasts

ASJC Scopus subject areas

  • Dermatology
  • Infectious Diseases

Cite this

Potenza, L., Chitasombat, M. N., Klimko, N., Bettelli, F., Dragonetti, G., Del Principe, M. I., ... Pagano, L. (2019). Rhodotorula infection in haematological patient: Risk factors and outcome. Mycoses, 62(3), 223-229. https://doi.org/10.1111/myc.12875

Rhodotorula infection in haematological patient : Risk factors and outcome. / Potenza, Leonardo; Chitasombat, Maria N.; Klimko, Nikolay; Bettelli, Francesca; Dragonetti, Giulia; Del Principe, Maria Ilaria; Nucci, Marcio; Busca, Alessandro; Fracchiolla, Nicola; Sciumè, Mariarita; Spolzino, Angelica; Delia, Mario; Mancini, Valentina; Nadali, Gian Paolo; Dargenio, Michela; Shadrivova, Olga; Bacchelli, Federico; Aversa, Franco; Sanguinetti, Maurizio; Luppi, Mario; Kontoyiannis, Dimitrios P.; Pagano, Livio.

In: Mycoses, Vol. 62, No. 3, 2019, p. 223-229.

Research output: Contribution to journalArticle

Potenza, L, Chitasombat, MN, Klimko, N, Bettelli, F, Dragonetti, G, Del Principe, MI, Nucci, M, Busca, A, Fracchiolla, N, Sciumè, M, Spolzino, A, Delia, M, Mancini, V, Nadali, GP, Dargenio, M, Shadrivova, O, Bacchelli, F, Aversa, F, Sanguinetti, M, Luppi, M, Kontoyiannis, DP & Pagano, L 2019, 'Rhodotorula infection in haematological patient: Risk factors and outcome', Mycoses, vol. 62, no. 3, pp. 223-229. https://doi.org/10.1111/myc.12875
Potenza L, Chitasombat MN, Klimko N, Bettelli F, Dragonetti G, Del Principe MI et al. Rhodotorula infection in haematological patient: Risk factors and outcome. Mycoses. 2019;62(3):223-229. https://doi.org/10.1111/myc.12875
Potenza, Leonardo ; Chitasombat, Maria N. ; Klimko, Nikolay ; Bettelli, Francesca ; Dragonetti, Giulia ; Del Principe, Maria Ilaria ; Nucci, Marcio ; Busca, Alessandro ; Fracchiolla, Nicola ; Sciumè, Mariarita ; Spolzino, Angelica ; Delia, Mario ; Mancini, Valentina ; Nadali, Gian Paolo ; Dargenio, Michela ; Shadrivova, Olga ; Bacchelli, Federico ; Aversa, Franco ; Sanguinetti, Maurizio ; Luppi, Mario ; Kontoyiannis, Dimitrios P. ; Pagano, Livio. / Rhodotorula infection in haematological patient : Risk factors and outcome. In: Mycoses. 2019 ; Vol. 62, No. 3. pp. 223-229.
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AU - Potenza, Leonardo

AU - Chitasombat, Maria N.

AU - Klimko, Nikolay

AU - Bettelli, Francesca

AU - Dragonetti, Giulia

AU - Del Principe, Maria Ilaria

AU - Nucci, Marcio

AU - Busca, Alessandro

AU - Fracchiolla, Nicola

AU - Sciumè, Mariarita

AU - Spolzino, Angelica

AU - Delia, Mario

AU - Mancini, Valentina

AU - Nadali, Gian Paolo

AU - Dargenio, Michela

AU - Shadrivova, Olga

AU - Bacchelli, Federico

AU - Aversa, Franco

AU - Sanguinetti, Maurizio

AU - Luppi, Mario

AU - Kontoyiannis, Dimitrios P.

AU - Pagano, Livio

PY - 2019

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N2 - Background: Rhodotorula spp are uncommon yeasts able to cause infections with high mortality rates. Rhodotorula infections have been associated with the presence of central venous catheter (CVC), immunosuppression, exposure to antifungals and the presence of either solid or haematologic malignancies. However, in this latter setting, only a few cases have so far been reported. Objectives: We have conducted a survey for Rhodotorula infections in haematologic patients. Methods: Patients’ clinical and microbiological data were collected and correlated to the outcome. Results: A total of 27 cases were detected from 13 tertiary care hospitals. About 78% and 89% of patients had acute leukaemia and CVC. About 70% of patients were exposed to prophylaxis with azoles, mainly posaconazole (37%), 59% were severely neutropenic and 37% underwent allogeneic stem cell transplantation (alloSCT). The most frequent treatments were liposomal amphotericin B (L-AmB) and CVC removal in 17 and 16 patients, respectively. One month post-diagnosis, mortality was 26% and was associated with the presence of mucositis (P = 0.034). Conclusions: Our study shows that Rhodotorula spp should be considered as aetiologic agents of breakthrough infections in acute leukaemia patients with a CVC, mucositis, who receive prophylaxis with azoles, including posaconazole, and/or undergo alloSCT. Prompt measures, such as L-AmB administration and CVC removal, should be carried out to avoid the high mortality risk of Rhodotorula infections.

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