Background: Candida krusei (CK) is resistant to Fluconazole and has been increasingly isolated in severe surgical infections particularly in immunocompromised hosts such as solid organ recipients (SOR). Methods: All cases of CK infection occurring during 18 months at the Innsbruck medical university were included. CK were grown on Sabouraud agar, chromosomal DNA was extracted using the QIAamp Tissue kit, clonality was investigated using RAPD - PCR with primers M13, OPA-18 and OPE-18. Results: Seven patients with CK infection were identified: all were treated on the transplant intensive care unit including one patient with pleural empyema following esophageal perforation and one patient with a ventricular assist device (AD) who developed CK pneumonia. The remaining patients were SORs including three pancreas recipients with intraabdominal infection, one liver recipient with ischemic cholangiopathy and CK cholangitis requiring retransplantation and a lung recipient with CK pleural empyema. Treatment consisted of caspofungin (3), voriconazole (1) and combination of the two (2); in one case no antifungal therapy was given after surgical removal of infected hematoma. Infected collections were evacuated surgically (n=3) or through pig-tail drainage (n=3). CK infection was successfully managed in all cases. The patient with the AD died from multi organ failure; one pancreas graft was lost. PCR analysis revealed five different CK strains; the first four patients in this series (i.e. 57%) harboured the identical CK strain, two patients had two different strains. Conclusions: CK infections represent increasing complications and clonal outbreaks must be considered on intensive care units with solid organ recipients being at particular risk. Rapid diagnosis and treatment with new antifungal agents allow successful therapy of these infections.
Full conference title:
46th Interscience Conference on Antimicrobial Agents and Chemotherapy
- ICAAC 46th