Background:
Saprochaete clavate is a rare emerging pathogen causing invasive fungal infections in immunocompromised patients. More than 90% of these infections have been reported in patients with hematological malignancies and are associated with high mortality rates (about 60%) in vulnerable patients. The transmission isn’t defined, but the available literature describes orofecal transmission as the most common source of infection (ext. contaminated medical devices, dishes, dairy products). Here we report 3 cases of fungal infections due to S.clavate, observed in 3 patients admitted to hematopoietic cell transplantation and cell therapies Unit of IRCCS Ospedale Policlinico San Martino, Genoa,Liguria, north-west Italy, between July and September 2022.

Methods:
We created an Excel database with positive patients for S.clavata: we investigated the clinical characteristics of the subjects, the details of the hospitalization, the transplant date and the date of infection.

Results:
Three positive cases for S.clavata were observed in a 50-day period in three hematological patients (mean age 60), all undergoing allogeneic stem cell transplantation during hospitalization. Two cases tested positive for S.clavata in blood culture and died within an average of 9 days of detection. The discharged patient presented positivity only to nasopharyngeal swab. All patients had persistent neutropenia and two of them had been treated with cytarabine and two of them had mucositis. The patients had been treated with micafungin and levofloxacin in the period prior to testing positive.The recovery rooms were single and distant from each other.

Conclusions:
Its important to investigate the emerging S.clavata as healthcare associated infection because of its dangerousness in vulnerable patients, to understand the mechanisms of transmission and infection and to implement interventions that limit its spread. Currently, the available literature is very small; therefore, its necessary to increase communication among international stakeholders about a pathogen which seems to be emerging as a public health problem.