Antibacterials
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Trichosporon asahii fungaemia: case report A 58-year-old man developed Trichosporon asahii fungaemia following treatment with ceftriaxone, imipenem/cilastatin, piperacillin/tazobactam for sepsis and vancomycin for suspected gram-positive bacteraemia [routes and dosages not stated]. The man presented to the hospital due to polytrauma after an alleged 12-foot fall. A left parietal scalp haematoma, a closed right humeral fracture, rib fractures that complicated by a right haemothorax and flail chest and vertebral spinous process fractures were noted. He underwent a chest tube insertion due to right haemothorax and then exploratory laparotomy was performed. Subsequently, liver lacerations with involvement of VII and VIII segments were noted and packing was carried out to control the bleeding. Post abdominal surgery, he was admitted to the ICU due to deterioration of haemodynamic status that required endotracheal intubation, blood transfusions and support with inotropes. Upon admission, he underwent investigation for sepsis and febrile episode that showed negative tracheal aspirate, blood and urine cultures. His total white blood cell count and the serum procalcitonin level were elevated. Therefore, he started receiving empirical broad spectrum antibiotics therapy with ceftriaxone initially and then piperacillin/tazobactam for coverage for sepsis was given. Despite treatment with piperacillin/tazobactam, he remained febrile and his total white blood cell count again increased. Thereafter, new specimens were taken for the investigation and another broad spectrum antibiotic imipenem/cilastatin was initiated. His specimen grew cloxacillin-resistant coagulase-negative Staphylococcus, and gram-positive bacteraemia was suspected. Therefore, he started receiving vancomycin. Five days later, his blood cultures showed positive results for urease-positive yeast. Dry, fuzzy and wrinkled white colonies of the yeast were noted upon incubation on sabouraud dextrose for 48 hours. A slide culture of the yeast on cornmeal agar was carried out and production of blastoconidia, pseudohyphae true hyphae and barrel-shaped arthroconidia was observed. A biochemical yeast identification test was performed that revealed Trichosporon asahii. Therefore, the man was treated with voriconazole that led a clinical improvement and he was shifted from the ICU to the general ward. It was concluded that his Trichosporon asahii fungaemia was secondary to broad spectrum antibiotic therapies with ceftriaxone, imipenem/cilastatin, piperacillin/tazobactam and vancomycin [durations of treatments to reaction onset not stated]. Ding CH, et al. Trichosporon asahii fungaemia in an immunocompetent polytrauma patient who received multiple antibiotics. Malaysian Journal of Pathology 42: 293-296, 803503155 No. 2, Aug 2020. Available from: URL: http://www.mjpath.org.my/2020/v42n2/trichosporon-asahii.pdf
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Reactions 26 Sep 2020 No. 1823
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