Successful treatment of a fluconazole low-susceptibility Kodamaea ohmeri bloodstream infection with micafungin: A case report and literature review.

Kodamaea ohmeri (formerly Pichia ohmeri) is a rare yeast-like fungus usually isolated from environmental sources such as insects and fruits, and human infections are uncommon. Since the first report in 1998, however, cases of bloodstream infection have been increasingly described, mainly in Asia. We report a case of K. ohmeri fungaemia associated with a peripherally inserted central catheter (PICC). A man in his sixties with diabetes mellitus developed fever during hospitalisation while the PICC was in place. Yeast-like fungi were detected in blood cultures and identified as K. ohmeri by MALDI-TOF mass spectrometry. Antifungal susceptibility testing showed susceptibility to micafungin and other echinocandins, and reduced susceptibility to fluconazole. Removal of the PICC and administration of micafungin led to resolution of clinical symptoms and negative blood cultures. A review of 52 published cases revealed a mortality rate of 30.8%, with about half associated with catheter use. As K. ohmeri is capable of biofilm formation, removal of the infection source appears crucial for favourable outcomes. This case represents successful treatment of a fluconazole low-susceptibility K. ohmeri fungaemia with micafungin, suggesting that this drug may be an effective therapeutic option.