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

BACKGROUND/PURPOSE: The yeast Kodamaea ohmeri rarely causes life-threatening human infections. However, risk factors, laboratory diagnoses, and treatments for K. 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.