Infections caused by Candida krusei in five transplant and two surgical patients.
BACKGROUND
Candida krusei (Ck) may cause severe infections in immunocompromised hosts and is innately resistant to fluconazole.


METHODS
During an 18-month period, seven patients with Ck infection were identified at our center. All were treated in the transplant intensive care unit. Candida isolates were grown on Sabouraud agar, and chromosomal DNA was extracted; clonality was investigated using random amplified polymorphic DNA-polymerase chain reaction with primers M13, OPA-18, and OPE-18.


RESULTS
Among the patients with Ck infection, there were three pancreas recipients with intra-abdominal infection, one liver recipient with cholangitis, one lung recipient with pleural empyema, one patient with pleural empyema after esophageal perforation, and one case of pneumonia in a patient with a ventricular assist device. Treatment consisted of caspofungin (n = 3), voriconazole (n = 1), or a combination of the two (n = 2) together with surgery (n = 3) or pigtail catheter drainage (n = 3). One patient underwent drainage without antifungal treatment, and one patient did not have drainage. The infection was controlled in all cases. The patient with the assist device died from multiple organ dysfunction, the lung recipient died after four months from graft failure, and one pancreas graft was lost. Four patients (57%) harbored the same Ck strain.


CONCLUSIONS
Solid organ recipients seem to be at particular risk for Ck infections; clonal outbreaks may occur in intensive care units.
Bonatti
Hugo
H
Department of General and Transplant Surgery, Innsbruck Medical University, Innsbruck, Austria. Hugo.Bonatti@dr.com
Stelzmueller
Ingrid
I
Berger
Natalie
N
Lechner
Matthias
M
Lechner
Mathias
M
Grif
Katharina
K
Geltner
Christian
C
Margreiter
Raimund
R
Lass-Flörl
Cornelia
C
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000145:classification* / Q000302:isolation & purification*; D002177:Candidiasis / Q000453:epidemiology / Q000382:microbiology*; D000077336:Caspofungin; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D016172:DNA Fingerprinting; D004271:DNA, Fungal / Q000235:genetics; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D005838:Genotype; D006801:Humans; D016867:Immunocompromised Host; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D016533:Mycological Typing Techniques / Q000379:methods; D016377:Organ Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000382:microbiology*; D011743:Pyrimidines / Q000627:therapeutic use; D019105:Random Amplified Polymorphic DNA Technique; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D004271:DNA, Fungal; D054714:Echinocandins; D055666:Lipopeptides; D011743:Pyrimidines; D014230:Triazoles; D000077336:Caspofungin; D065819:Voriconazole