title: Molecular typing for investigating an outbreak of Candida krusei.
abstract: Invasive infections due to Candida krusei are often observed in immunocompromised patients who have received prior therapy with fluconazole, although infection has also occurred in patients in the absence of this antifungal agent. From August 25 through September 19, 1995, we identified four patients with C. krusei fungemia on our hematology/oncology unit. Molecular typing of all the isolates was performed by restriction endonuclease analysis of genomic DNA using HinfI. A total of 7 patients found to be colonized or infected with C. krusei were matched with 14 controls. There was no difference between the cases and controls with respect to underlying disease, duration of hospitalization, or neutropenia. The numbers of days of hyperalimentation, corticosteroids, and antibiotics were similar between both groups. The mean number of antibiotics was greater in the cases versus controls (5.0 versus 2.5; p = .003). There was no difference with respect to total dose or duration of fluconazole administration. Molecular typing of the isolates revealed that four had identical DNA banding patterns, plus another two that differed by one band and were considered related. Three historical strains were unrelated. In conclusion, this report demonstrates that molecular typing can be used to define clonality and, thereby, support increased infection control practices to eliminate such outbreaks when evidence of clonal spread is present.
authors.affiliation: Division of Infectious Diseases, Northwestern University Medical School, Chicago, IL 60611, USA.
authors.forename: G A
authors.initials: GA
authors.lastname: Noskin
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.forename: D M
authors.initials: DM
authors.lastname: Hacek
authors.forename: M
authors.initials: M
authors.lastname: Postelnick
authors.forename: B E
authors.initials: BE
authors.lastname: Reisberg
authors.forename: V
authors.initials: V
authors.lastname: Stosor
authors.forename: S A
authors.initials: SA
authors.lastname: Weitzman
authors.forename: L R
authors.initials: LR
authors.lastname: Peterson
mesh_terms: D000666:Amphotericin B / Q000494:pharmacology; D000935:Antifungal Agents / Q000494:pharmacology; D002175:Candida / Q000145:classification* / Q000187:drug effects / Q000235:genetics; D002177:Candidiasis / Q000453:epidemiology / Q000382:microbiology*; D016022:Case-Control Studies; D004262:DNA Restriction Enzymes; D004271:DNA, Fungal / Q000032:analysis; D004196:Disease Outbreaks; D005260:Female; D015725:Fluconazole / Q000494:pharmacology; D016469:Fungemia / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D017964:Itraconazole / Q000494:pharmacology; D007654:Ketoconazole / Q000494:pharmacology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole; D004262:DNA Restriction Enzymes; D007654:Ketoconazole