MOLECULAR TYPING FOR INVESTIGATING AN OUTBREAK OF CANDIDA-KRUSEI

Invasive infections due to Candida krusei ave often observed in immuno compromised patients who have received prior therapy with fluconazole, although infection has also occurred in patients in the absence of th is antifungal agent. From August 25 through September 19, 1995, we ide ntified four patients with C. krusei fungemia on our hematology/oncolo gy unit. Molecular typing of all the isolates was performed by restric tion endonuclease analysis of genomic DNA using HinfI. A total of 7 pa tients found to be colonized or infected with C. krusei were matched w ith 14 controls. There tons no difference between the cases and contro ls with respect to underlying disease, duration of hospitalization, or neutropenia. The numbers of days of hyperalimentation, corticosteroid s, and antibiotics were similar between both groups. The mean number o f 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 dur ation of fluconazole administration. Molecular typing of the isolates revealed that four had identical DNA banding patterns, plus another tw o that differed by one band and were considered related. Three histori cal strains were unrelated. In conclusion, this report demonstrates th at molecular typing can be used to define clonality and, thereby, supp ort increased infection control practices to eliminate such outbreaks when evidence of clonal spread is present. (C) 1997 Elsevier Science I nc.