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Watery diarrhoea and Saccharomyces fungaemia: case report A 77-year-old woman developed watery diarrhoea and Saccharomyces fungaemia during treatment with clindamycin, colistin, meropenem, piperacillin/tazobactam and teicoplanin. Additionally, Saccharomyces containing probiotic was also responsible for Saccharomyces fungaemia [dosages not stated]. The woman, who had uncontrolled diabetes, chronic obstructive airway disease and hypertension, was admitted to the ICU with a diagnosis of bilateral pneumonia with acute kidney injury. In view of respiratory distress, she was intubated, and a subclavian central line was inserted to start vasopressors. Initially, she was managed with piperacillin/tazobactam injection along with clindamycin injection. Later, this was changed to meropenem and teicoplanin injection in view of rising leucocyte counts. As the culture of endotracheal tube secretions reported carbapenem resistant organism, colistin injection was added. On day 5 of admission, fluconazole was added empirically. On day 7, the woman developed watery diarrhoea, for which metronidazole, Saccharomyces containing probiotic [sachet] and racecadotril were added with presumption of antibiotic induced diarrhoea or C. difficile infection. Stool routine/microscopy, toxin and culture for C. difficile were found to be negative. Her diarrhoea resolved. Three days after the start of probiotics, she developed hypotension and diarrhoea again. Fluconazole was changed to caspofungin, and all cultures were repeated. The initial report of the blood culture following 48 hours were sterile. After 4 days, blood from peripheral line and central line revealed growth of yeast, which was reported as Saccharomyces cerevisiae. A diagnosis of Saccharomyces fungaemia was considered. Treatment with caspofungin was stopped, and she was initiated on amphotericin B. Therapy with Saccharomyces containing probiotic was discontinued, and the central line was removed. Repeat blood cultures performed on the third and seventh day following the positive report showed no fungal growth. However, 24 days post admission, she died [immediate cause of death not stated]. Gupta P, et al. Saccharomyces: A friend or Foe in ICU (A case Report with solution). Indian Journal of Critical Care Medicine 23: 430-431, No. 9, Sep 2019. Available from: 803506987 URL: http://doi.org/10.5005/jp-journals-10071-23239

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Reactions 10 Oct 2020 No. 1825