title: Epidemiological investigation of Candida species causing bloodstream infection in paediatric small bowel transplant recipients.
abstract: Small bowel transplantation (SBT) can be a life-saving medical procedure. However, these recipients experience high risk of bloodstream infections caused by Candida. This research aims to characterise the SBT recipient gut microbiota over time following transplantation and investigate the epidemiology of candidaemia in seven paediatric patients. Candida species from the recipients' ileum and bloodstream were identified by internal transcribed spacer sequence and distinguished to strain by multilocus sequence typing and randomly amplified polymorphic DNA. Antifungal susceptibility of bloodstream isolates was determined against nine antifungals. Twenty-two ileostomy samples harboured at least one Candida species. Fungaemia were caused by Candida parapsilosis, Candida albicans, Candida glabrata, Candida orthopsilosis and Candida pelliculosa. All but three bloodstream isolates showed susceptibility to all the antifungals tested. One C. glabrata isolate showed multidrug resistance to itraconazole, amphotericin B and posaconazole and intermediate resistance to caspofungin. Results are congruent with both endogenous (C. albicans, C. glabrata) and exogenous (C. parapsilosis) infections; results also suggest two patients were infected by the same strain of C. parapsilosis. Continuing to work towards a better understanding of sources of infection-particularly the exogenous sources-would lead to targeted prevention strategies.
authors.affiliation: Department of Food Science & Technology, University of Nebraska-Lincoln, Lincoln, NE, USA.
authors.forename: Mallory J
authors.initials: MJ
authors.lastname: Suhr
authors.affiliation: Department of Food Science & Technology, University of Nebraska-Lincoln, Lincoln, NE, USA.
authors.forename: João Carlos
authors.initials: JC
authors.lastname: Gomes-Neto
authors.affiliation: Department of Food Science & Technology, University of Nebraska-Lincoln, Lincoln, NE, USA.
authors.forename: Nabaraj
authors.identifier: http://orcid.org/0000-0001-7293-0440
authors.initials: N
authors.lastname: Banjara
authors.affiliation: Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, NE, USA.|Transplant Surgery Division, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Diana F
authors.initials: DF
authors.lastname: Florescu
authors.affiliation: Transplant Surgery Division, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Mercer
authors.affiliation: Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Iwen
authors.affiliation: Department of Food Science & Technology, University of Nebraska-Lincoln, Lincoln, NE, USA.
authors.forename: Heather E
authors.identifier: http://orcid.org/0000-0002-1929-725X
authors.initials: HE
authors.lastname: Hallen-Adams
mesh_terms: D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D058387:Candidemia / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D000077336:Caspofungin; D004271:DNA, Fungal / Q000235:genetics; D025141:Drug Resistance, Fungal; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology* / Q000637:transplantation; D017964:Itraconazole / Q000627:therapeutic use; D055666:Lipopeptides / Q000627:therapeutic use; D008297:Male; D058885:Multilocus Sequence Typing; D017422:Sequence Analysis, DNA; D066027:Transplant Recipients; D014230:Triazoles / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D054714:Echinocandins; D055666:Lipopeptides; D014230:Triazoles; D017964:Itraconazole; C101425:posaconazole; D000666:Amphotericin B; D000077336:Caspofungin
keywords: candidaemia; fungaemia; microbiota; mycobiota