FUNGEMIA POR SACCHAROMYCES CEREVISIAE ASSOCIADA AO USO DO PROBIÓTICO S. CEREVISIAE VAR BOULARDII. RELATO DE UMA SÉRIE DE CASOS E REVISÃO SISTEMÁTICA DA LITERATURA

Abstract

Saccharomyces cerevisiae is a fungus that is widespread in nature, considered non-pathogenic and used in the manufacture of food and probiotic products. An increase in bloodstream infections by Saccharomyces cerevisiae has been observed, associated with the use of probiotics to treat diarrhea, mainly in hospitalized patients. The objective of this study was to describe clinical features of S. cerevisiae fungemia and to evaluate aspects of S. cerevisiae isolates from a series of cases that occurred in a tertiary hospital in Mato Grosso do Sul and from previously published cases. In the first stage, clinical and laboratory data of five patients admitted to a tertiary hospital in Mato Grosso do Sul, in whose blood samples S. cerevisiae were identified, were collected. The isolates were submitted to antifungal susceptibility tests, molecular analysis and evaluation of biofilm production. Next, a systematic review was carried out, including case reports and series of cases of fungemia after probiotic treatment. Regarding the five cases in this study, four had used probiotic and it was possible to demonstrate the genetic similarity of the five isolates with the probiotic strain. All isolates showed low capacity for biofilm formation, while the probiotic isolate showed moderate capacity. Three patients were diagnosed with bloodstream infection, one with transient fungemia and one with endocarditis. In the systematic review, 75 cases were observed -71 cases from the literature and four cases from the series of cases reported here who used probiotics. France, Brazil and Belgium were the countries that reported the most cases. The predominant age group was between 60 and 79 years (30.7%). Immunosuppression was reported in 28% of cases. About a quarter of the patients (25.3%) died. The most used antifungal drugs were fluconazole (38.7%) and amphotericin B (20.0%). Broth microdilution antifungigram of 15 isolates revealed that: i) more than half (n=8; 53.3%) had MIC ≥ 8 ug/mL for fluconazole; ii) about a quarter (n=4; 26.7%) were non-wild for amphotericin B; iii) one HRMS isolate showed MIC >16 ug/ml for both echinocandidates tested (caspofungin and micafungin). Clinical breakpoints have not yet been established for S. cerevisiae, however, the high MIC values for several antifungals observed reinforce concern about the emergence of resistant S. cerevisiae.

Descriptors: Saccharomyces cerevisiae, epidemiology, invasive infection, antifungigram.