Trichosporon asahii as an emerging etiologic agent of fungal infection and colonization in heart failure patients in the intensive care unit: epidemiologic characteristics of a 44-patient cohort

Introduction

In the last years, the fungal infection incidence is increasing progressively in severely ill patients in the ICU. Trichosporon asahii (TA) (formerly Trichosporon beigelii) reported risk factors for infection less usually include acquired immuno-deficiency caused by drugs, AIDS and critical illness in patients with chronic comorbidities. There is no description of these infections in heart failure patients in the ICU.

Objective

To describe the characteristics of a cohort of severely ill patients colonized or infected by TA in a medical ICU.

Methods

A 5.5-year (January 2000–July 2005) retrospective study of all urinary tract infections/colonizations that occurred in a tertiary care ICU of a teaching hospital.

Results

Among 585 urinary tract infections (UTI) and colonization episodes, 253 (43%) were caused by fungi. Of these, 44 (17%) were caused by TA. They were divided into two groups: GI, symptomatic UTI; and GII, colonization (NNISS – CDC Atlanta). In GI, n = 24 patients with age 68 ± 12 years, 71% were male. The ICU length of stay (LOS) before the diagnosis was 34 ± 39 days. These patients had an ejection fraction (EF) of 42 ± 19% (62% had EF <40%). Fifty percent had renal failure (Cr > 2.0), creatinine 2.3 ± 1.3 mg/dl. Inhospital mortality was 83%. Three UTI episodes were observed in 2000–2001, 14 in 2002–2003 and seven in 2004–2005. One patient of GI had bloodstream infection. In GII, n = 20 patients with age 73 ± 11 years, 70% were male. The ICU LOS before diagnosis was 26 ± 18 days. EF was 40 ± 14% (65% had EF <40%). Fifty-five percent had renal failure, creatinine 2.3 ± 1.2 mg/dl. Inhospital mortality was 85%.

Conclusion

Although the overwhelming majority of cases of TA infection had been described in haematologic patients, these data highlight the importance of considering severely ill heart failure patients as a risk group for TA infection/colonization in the ICU. High mortality in both groups, despite infection or colonization, reinforces TA as a marker of severity in these patients.