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Volume 43, Number 3, June 2010

The Emerging Life-threatening Opportunistic Fungal Pathogen Kodamaea ohmeri: Optimal Treatment and Literature Review


Shih-Ta Shang, Jung-Chung Lin, Su-Jean Ho, Ya-Sung Yang, Feng-Yee Chang, Ning-Chi Wang


Received: February 17, 2009    Revised: April 30, 2009    Accepted: June 26, 2009   

 

Corresponding author:

 Ning-Chi Wang

Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine,

Tri-Service General Hospital, National Defense Medical Center, 7F, 325 Section 2, Cheng-Kung Road, Neihu 114, Taipei,

Taiwan.

E-mail: wangmax49@gmail.com

 



 

Background and purpose: 

The yeast Kodamaea ohmeri rarely causes life-threatening human infections. However, risk factors, laboratory diagnoses, and treatments forK. ohmeri infection have been limited, and the optimal therapy for K. ohmeri infection has not been identified.



 

Methods:

Twenty cases of K. ohmeri infection have been reported in the English medical literature. We present two new cases of K. ohmeri fungemia. We investigated the nature and treatment of K. ohmeri infections using minimum inhibitory concentrations of antifungal agents and by comparing the two cases with those described in the literature.



 

Results:

From March 1998 to December 2008, a total of 22 patients with K. ohmeri infections were studied. Hematological malignancies and diabetes were the most common co-morbidities for K. ohmeri infections, with crude prevalence rates of 27.3% and 18.2%, respectively. The K. ohmeri isolates showed less susceptibility to fluconazole but greater susceptibility to amphotericin B [15/25 isolates (60%) vs. 25/25 isolates (100%), respectively]. Good outcomes (8/9 cases; 88.9%) were found following removal of indwelling catheters and implants. In addition, voriconazole and echinocandins, such as caspofungin and micafungin, also showed excellent minimum inhibitory concentrations against K. ohmeri.



 

Conclusion:

K. ohmeri should not be regarded as a contaminant of blood cultures. Favorable outcomes for this potentially life-threatening infection are promoted by the removal of indwelling catheters; furthermore, outcomes are associated with optimal antifungal regimens, especially voriconazole and echinocandins.



 

Key words:

echinocandins fluconazole fungemia Kodamaea ohmeri voriconazole