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Catheter-related sepsis due to Rhodotorula glutinis
Po-Ren Hsueh1, Lee-Jene Teng, Shen-Wu Ho
1Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. hsporen@ha.mc.ntu.edu.tw
Abstract:
We describe a central venous catheter-related (Port-A-Cath; Smiths Industries Medical Systems [SIMS] Deltec, Inc., St. Paul, Minn.) infection caused by Rhodotorula glutinis in a 51-year-old man with nasopharyngeal carcinoma. He was treated with fluconazole for 8 weeks and had the catheter removed. Two isolates of R. glutinis recovered from blood specimens (one obtained via peripheral veins and one via the catheter) before administration of fluconazole and one recovered from the removed catheter 17 days after initiation of fluconazole therapy exhibited high-level resistance to fluconazole (MICs, >256 microg/ml). These three isolates were found to belong to a single clone on the basis of identical antibiotypes determined by the E test (PDM Epsilometer; AB Biodisk, Solna, Sweden) and biotypes determined by API ID32 C (bioMerieux, Marcy I'Etoile, France) and their identical random amplified polymorphic DNA patterns.
Insights
A rare Rhodotorula glutinis bloodstream infection occurred in a patient with nasopharyngeal carcinoma. The yeast developed high-level fluconazole resistance, complicating treatment of this central venous catheter-related infection.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Clinical Microbiology
Background:
- Central venous catheters are essential for long-term therapies but pose infection risks.
- Nasopharyngeal carcinoma patients often require indwelling devices, increasing susceptibility to infections.
- Rhodotorula glutinis is an opportunistic yeast, infrequently implicated in human infections.
Observation:
- A 51-year-old man with nasopharyngeal carcinoma developed a bloodstream infection associated with a central venous catheter (Port-A-Cath).
- The infection was caused by Rhodotorula glutinis, a yeast not commonly causing such severe infections.
- The patient was treated with fluconazole, an antifungal medication, and the catheter was removed.
Findings:
- Multiple isolates of Rhodotorula glutinis were recovered from the patient's blood and catheter.
- These isolates demonstrated high-level resistance to fluconazole (MICs >256 microg/ml) despite treatment.
- Molecular typing (antibiotype, biotype, RAPD) confirmed all isolates belonged to a single clone.
Implications:
- This case highlights the potential for Rhodotorula glutinis to cause serious, resistant infections in immunocompromised patients.
- High-level fluconazole resistance in Rhodotorula glutinis necessitates careful monitoring and alternative treatment strategies.
- Understanding the clonal nature of resistant strains is crucial for infection control and therapeutic management.