Catheter associated urinary tract infections due to Trichosporon asahii

Area of Science:

• Medical Mycology
• Infectious Diseases
• Clinical Microbiology

Background:

• Fungal urinary tract infections (UTIs) are increasingly recognized, particularly in hospitalized patients, often linked to medical devices.
• Limited data exists on the epidemiology, diagnosis, and treatment of Trichosporon species, including Trichosporon asahii, due to identification challenges and lack of standardized in vitro sensitivity testing.
• Sporadic reports of Trichosporon asahii UTIs exist, but comprehensive case series are scarce.

Observation:

• This study reports six cases of UTI caused by Trichosporon asahii in severely ill patients at a tertiary care center.
• All affected patients had indwelling urinary catheters, received broad-spectrum antibiotics, and had significant comorbidities.
• Trichosporon asahii isolates demonstrated resistance to amphotericin B but sensitivity to voriconazole, with variable sensitivity to itraconazole and fluconazole.

Findings:

• Trichosporon asahii was confirmed as the etiological agent of UTI through isolation from consecutive urine samples with significant counts and pus cells.
• Risk factors identified include antibiotic use, indwelling catheters, and comorbidities like hypertension, diabetes, anemia, and chronic kidney disease.
• Successful treatment involved antifungal therapy and removal of the indwelling urinary catheter, leading to patient recovery and fungal clearance.

Implications:

• These findings highlight the growing threat of Trichosporon asahii in hospital-acquired UTIs and the need for improved diagnostic and therapeutic strategies.
• The study underscores the importance of considering fungal pathogens in UTIs, especially in immunocompromised or critically ill patients with risk factors.
• Antifungal susceptibility patterns suggest voriconazole as a potential primary treatment option for T. asahii UTIs, warranting further clinical investigation.