Epidemiology, clinical and microbiologic aspects of Rhodotorula fungemia: A review of reported cases over the past 16 years.

Rhodotorula species are basidiomycetous yeasts, commonly recognized as emerging opportunistic pathogens, particularly in immunocompromised patients. Fungemia is the most common presentation of Rhodotorula infections, which in the vast majority of cases is associated with the presence of central venous catheters (CVCs). This review evaluated all published documented cases of Rhodotorula fungemia between 2010 and 2025. We searched PubMed and Scopus databases for articles providing data related to the epidemiology, clinical features, microbiology, treatment and outcome of Rhodotorula fungemia over the past 16 years. A total of 32 studies involving 39 patients with Rhodotorula fungemia were identified. The mean patient age was 47.4 years and most (61.5%) were male. Comorbidities were common in 97.4% of the patients. Hematologic malignancies were the most frequent underlying condition. Use of CVCs, immunosuppressive therapy, use of broad-spectrum antibiotics, neutropenia and total parenteral nutrition were the main risk factors (56.4%, 51.3%, 66.7%, 40%, and 7.7%, respectively). Identification was most frequently performed using molecular methods (46.2%) and R. mucilaginosa was the predominant species (71.8%). Fever represented the most frequent clinical presentation (63.3%). Amphotericin B (AmB) and 5-flucytosine demonstrated good in vitro activity against Rhodotorula isolates. Treatment frequently involved administration of AmB, combined with catheter removal in those having CVCs. The mortality rate attributed to the infection was 10.3%. Rhodototula is an emerging but uncommon cause of non-Candida fungemia. Rapid and accurate identification of the yeast is critical to avoid inappropriate therapy. Early identification and prompt administration of tailored treatment are vital for improving patient outcomes.