Cyberlindnera fabianii in the neonatal and paediatric intensive care unit: case reports

Introduction: The number of infections due to uncommon yeast species is gradually increasing worldwide. In cases of high-risk paediatric patients, Cyberlindnera fabianii has been identified as the causal agent in a number of countries. In fact, we have recently reported the first proven occurrence, to the best of our knowledge, of this species as a causal agent of fungaemia in three neonatal patients in a Croatian hospital. Case presentation: We report here six new instances of clinically manifested bloodstream and urinary tract infections caused by Cyberlindnera fabianii in five high-risk neonates and one child, during a 5-year period (2008–2012) in the aforementioned Croatian hospital. In addition, we have provided an account of their treatment strategy and the outcome, and the susceptibility profiles of 44 isolates of Cyberlindnera fabianii to amphotericin B, flucytosine, triazoles and echinocandins. Furthermore, we have described a novel molecular method suitable for the rapid and specific diagnosis of this species. Conclusion: Our findings demonstrated: (i) the pathogenic activities of Cyberlindnera fabianii species in high-risk children; (ii) that administering fluconazole either prophylactically or therapeutically yielded no results in 50 % of the patients; (iii) that substituting fluconazole by liposomal amphotericin B or caspofungin managed to resolve sepsis in the remaining 50 % of patients; (iv) that, according to the examined sequences, all of the Cyberlindnera fabianii isolates were found to be identical independent of their source or study period; and (v) the existence of a higher proportion of non-susceptible isolates of Cyberlindnera fabianii for echinocandins (especially micafungin) compared with the other tested antifungals.