title: Epidemiology of Candida kefyr in patients with hematologic malignancies.
abstract: Candida kefyr is an emerging pathogen among patients with hematologic malignancies (HM). We performed a retrospective study at Johns Hopkins Hospital to evaluate the epidemiology of C. kefyr colonization and infection in HM patients between 2004 and 2010. Eighty-three patients were colonized and/or infected with C. kefyr, with 8 (9.6%) having invasive candidiasis (IC). The yearly incidence of C. kefyr colonization and candidemia increased over the study period (P < 0.01), particularly after 2009. In 2010, C. kefyr caused 16.7% of candidemia episodes. The monthly incidence of C. kefyr was higher during the summer throughout the study. In a cohort of patients with acute myelogenic leukemia receiving induction chemotherapy, risks for C. kefyr colonization included the summer season (odds ratio [OR], 3.1; P = 0.03); administration of an azole (OR, 0.06; P < 0.001) or amphotericin B (OR, 0.35; P = 0.05) was protective. Fingerprinting of 16 isolates by repetitive sequence-based PCR showed that all were different genotypes. The epidemiology of C. kefyr candidemia was evaluated in another hospital in Montreal, Canada; data confirmed higher rates of C. kefyr infection in the summer. C. kefyr appears to be increasing in HM patients, with prominent summer seasonality. These findings raise questions about the effect of antifungal agents and health care exposures (e.g., yogurt) on the epidemiology of this yeast.
authors.affiliation: Division of Infectious Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Microbiology and Immunology, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Simon F
authors.initials: SF
authors.lastname: Dufresne
authors.affiliation: Division of Infectious Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA kmarr4@jhmi.edu.
authors.forename: Kieren A
authors.initials: KA
authors.lastname: Marr
authors.affiliation: Division of Infectious Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Sydnor
authors.affiliation: Division of Infectious Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Janet F
authors.initials: JF
authors.lastname: Staab
authors.affiliation: Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Karp
authors.affiliation: Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Hematology, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Kit
authors.initials: K
authors.lastname: Lu
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Sean X
authors.initials: SX
authors.lastname: Zhang
authors.affiliation: Department of Microbiology and Immunology, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Lavallée
authors.affiliation: Division of Infectious Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Epidemiology and Infection Prevention, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
authors.affiliation: Division of Infectious Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Dionysios
authors.initials: D
authors.lastname: Neofytos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D002175:Candida / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D058365:Candidiasis, Invasive / Q000453:epidemiology* / Q000382:microbiology*; D016172:DNA Fingerprinting; D004271:DNA, Fungal / Q000235:genetics; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D058889:Molecular Typing; D016533:Mycological Typing Techniques; D012189:Retrospective Studies; D012621:Seasons; D055815:Young Adult
chemical_list: D004271:DNA, Fungal