Invasive Trichosporon Infection in Solid Organ Transplant Recipients: A Single-Center Experience in Madrid, Spain

Invasive fungal infections are a major threat in solid organ transplant (SOT) recipients. Trichosporon spp. are emerging yeasts associated with high mortality and therapeutic difficulties.

Retrospective study of SOT recipients with invasive Trichosporon spp. infection at a tertiary hospital in Spain (2017-2025) was performed. Demographic, clinical, microbiological, and outcome data were analyzed.

Sixteen patients (56.2% male; median age 54 years) (lung: eight; heart: five; liver: three) with infection due to Trichosporon austroamericanum were included. Hospital mortality was 50% (8 out of 16 patients). The infection originated at the surgical site in 14 cases (87.5%), with progression to fungemia in 6 patients, all of whom died. Univariate analysis identified breakthrough infection (p = 0.010), concomitant antibiotics (p = 0.026), high-dose corticosteroid therapy (p = 0.020), and ICU admission at diagnosis (p = 0.001) as risk factors for mortality. All strains exhibited favorable in vitro susceptibility to voriconazole, isavuconazole, posaconazole and amphotericin B and high MICs for echinocandins.

Invasive Trichosporon spp. infection in SOT recipients is linked to considerable mortality, especially in surgical site infections complicated by fungemia. Mortality is associated with severe immunosuppression, breakthrough infection, concomitant antibiotics, ICU admission, and delayed diagnosis. The combined administration of broad-spectrum antibiotics and echinocandins was associated with mortality.