Abstract Saccharomyces cerevisiae has increasingly been recognized as an opportunistic pathogen. Sterile-site infections remain rare but are associated with substantial morbidity and mortality, especially in critically ill patients. This study aimed to characterize the epidemiological, clinical, and microbiological characteristics of sterile-site S. cerevisiae infections. We performed a retrospective analysis of all patients with S. cerevisiae isolated from sterile body sites between January 2019 and December 2025. Demographic data, underlying conditions, probiotic exposure, antifungal therapy, and outcomes were collected, and antifungal susceptibility testing was performed. Among 196 patients with S. cerevisiae isolates, 30 (15%) had sterile-site infections. The mean age was 47.2 years, and 23% were paediatric cases. Bloodstream infections were the most common source (n = 7, 23%), followed by intra-abdominal abscess aspirates and drained intra-abdominal wounds (each n = 5, 17%). Intensive care unit (ICU) admission occurred in 33%, prior gastrointestinal surgery in 63%, central venous catheter usage in all fatal cases, and prior probiotic exposure in 30%. Overall, 30-day mortality was 27%. In multivariable analysis, increasing age (adjusted OR 1.11 per year, 95% CI 1.02–1.37; p = 0.008) and ICU admission (adjusted OR 10.09, 95% CI 1.23–259.6; p = 0.03) were independent predictors of mortality. Fluconazole showed variable activity, whereas amphotericin B and echinocandins demonstrated low minimal inhibitory concentrations. Rare sterile-site S. cerevisiae infections are associated with high mortality related to host factors such as age and critical illness, supporting cautious probiotic use and first-line amphotericin B or echinocandins.
Harmath et al. (Thu,) studied this question.