Abstract
BackgroundCandida krusei infections are associated with high mortality. In order to explore ways to prevent these infections, we investigated potential routes for nosocomial spread and possible clonality of C. krusei in a haematological unit which had experienced an unusually high incidence of cases.MethodsWe searched for C. krusei contamination of the hospital environment and determined the level of colonization in patients and health care workers. We also analyzed the possible association between exposure to prophylactic antifungals or chemotherapeutic agents and occurrence of C. krusei. The C. krusei isolates found were genotyped by pulsed-field electrophoresis method in order to determine possible relatedness of the cases.ResultsTwelve patients with invasive C. krusei infection and ten patients with potentially significant infection or mucosal colonization were documented within nine months. We were unable to identify any exogenic source of infection or colonization. Genetic analysis of the isolates showed little evidence of clonal transmission of C. krusei strains between the patients. Instead, each patient was colonized or infected by several different closely related genotypes. No association between medications and occurrence of C. krusei was found.ConclusionLittle evidence of nosocomial spread of a single C. krusei clone was found. The outbreak may have been controlled by cessation of prophylactic antifungals and by intensifying infection control measures, e.g. hand hygiene and cohorting of the patients, although no clear association with these factors was demonstrated.
Highlights
Candida krusei infections are associated with high mortality
Outbreak description and infection control measures taken In February 2005, an increase in the number of cultureconfirmed C. krusei infections was recognized in the haematological ward
In three haematology patients the clinical presentation was consistent with invasive fungal infection and they were colonized by C. krusei (Table 1, patients 13 – 15)
Summary
Candida krusei infections are associated with high mortality. An increase in prevalence of species of Candida other than C. albicans, such as Candida glabrata and Candida krusei, has been recognized in some hospitals (page number not for citation purposes). A number of fungal pathogens are inherently resistant to fluconazole and amphotericin B and require alternative antifungals, such as echinocandins or the newer azoles. Invasive infections or colonization with C. krusei has been associated with prophylactic use of antifungals [4,11,12]. The role of the prophylactic fluconazole, has not been evident in all outbreak settings and other antimicrobial agents may contribute to colonization with the species of Candida other than C. albicans [13,14,15]
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