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dc.contributor.authorAsmundsdottir, Lena Ros
dc.contributor.authorErlendsdottir, Helga
dc.contributor.authorHaraldsson, Gunnsteinn
dc.contributor.authorGuo, Hong
dc.contributor.authorXu, Jianping
dc.contributor.authorGottfredsson, Magnus
dc.date.accessioned2011-03-28T11:24:00Z
dc.date.available2011-03-28T11:24:00Z
dc.date.issued2008-07-15
dc.date.submitted2011-03-28
dc.identifier.citationClin. Infect. Dis. 2008, 47(2):e17-24en
dc.identifier.issn1537-6591
dc.identifier.pmid18549311
dc.identifier.doi10.1086/589298
dc.identifier.urihttp://hdl.handle.net/2336/125831
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractBACKGROUND: Invasive fungal infections pose a serious threat to hospitalized patients worldwide. In particular, the prevalence of clusters of nosocomial infection among patients with candidemia remains unknown. The aim of this study was to investigate the molecular epidemiology of candidemia in a nationwide setting in Iceland during a 16-year period. METHODS: The genotypes of all available fungal bloodstream isolates during 1991-2006 (n = 219) were determined by polymerase chain reaction fingerprinting with use of 4 separate primers. Clusters were defined as isolation of > or =2 strains with genotypes that had > or =90% relatedness in the same hospital within a period of 90 days. RESULTS: Candida albicans represented 61.6% of isolates, followed by Candida glabrata (13.7%), Candida tropicalis (9.1%), and Candida parapsilosis (8.7%). Polymerase chain reaction fingerprinting revealed 35 clones of C. albicans, 10 clones of C. glabrata, 7 clones of C. tropicalis, 4 clones of C. parapsilosis, and 5 clones of Candida dubliniensis. Overall, 18.7%-39.9% of all infections were part of nosocomial clusters, most commonly caused by C. albicans, C. parapsilosis, and C. tropicalis. Most clusters involved 2 cases and disproportionately affected patients in adult and neonatal intensive care units (P = .045). The 7-day (16%) and 30-day (32%) case-fatality rates among cluster-associated cases did not differ statistically significantly from those for sporadic nosocomial infections. None of the clusters were identified by the hospital surveillance team. CONCLUSIONS: In an unselected patient population, as many as one-third of all cases of candidemia may be attributable to nosocomial clusters. The risk is dependent on hospital wards and patient populations; it is highest in intensive care units. Small clusters are not identified by routine hospital surveillance.
dc.language.isoenen
dc.relation.urlhttp://dx.doi.org/10.1086/589298en
dc.subject.meshAdulten
dc.subject.meshCandidaen
dc.subject.meshCandidiasisen
dc.subject.meshChilden
dc.subject.meshCluster Analysisen
dc.subject.meshCross Infectionen
dc.subject.meshDNA Fingerprintingen
dc.subject.meshDNA Primersen
dc.subject.meshDNA, Fungalen
dc.subject.meshDisease Outbreaksen
dc.subject.meshFemaleen
dc.subject.meshFungemiaen
dc.subject.meshGenotypeen
dc.subject.meshHumansen
dc.subject.meshIcelanden
dc.subject.meshIncidenceen
dc.subject.meshInfant, Newbornen
dc.subject.meshIntensive Care Unitsen
dc.subject.meshIntensive Care Units, Neonatalen
dc.subject.meshMaleen
dc.subject.meshMolecular Epidemiologyen
dc.subject.meshPolymerase Chain Reactionen
dc.subject.meshPrevalenceen
dc.subject.meshRetrospective Studiesen
dc.titleMolecular epidemiology of candidemia: evidence of clusters of smoldering nosocomial infectionsen
dc.typeArticleen
dc.contributor.departmentFaculty of Medicine, University of Iceland, Reykjavik, Iceland.en
dc.identifier.journalClinical infectious diseases : an official publication of the Infectious Diseases Society of Americaen
html.description.abstractBACKGROUND: Invasive fungal infections pose a serious threat to hospitalized patients worldwide. In particular, the prevalence of clusters of nosocomial infection among patients with candidemia remains unknown. The aim of this study was to investigate the molecular epidemiology of candidemia in a nationwide setting in Iceland during a 16-year period. METHODS: The genotypes of all available fungal bloodstream isolates during 1991-2006 (n = 219) were determined by polymerase chain reaction fingerprinting with use of 4 separate primers. Clusters were defined as isolation of > or =2 strains with genotypes that had > or =90% relatedness in the same hospital within a period of 90 days. RESULTS: Candida albicans represented 61.6% of isolates, followed by Candida glabrata (13.7%), Candida tropicalis (9.1%), and Candida parapsilosis (8.7%). Polymerase chain reaction fingerprinting revealed 35 clones of C. albicans, 10 clones of C. glabrata, 7 clones of C. tropicalis, 4 clones of C. parapsilosis, and 5 clones of Candida dubliniensis. Overall, 18.7%-39.9% of all infections were part of nosocomial clusters, most commonly caused by C. albicans, C. parapsilosis, and C. tropicalis. Most clusters involved 2 cases and disproportionately affected patients in adult and neonatal intensive care units (P = .045). The 7-day (16%) and 30-day (32%) case-fatality rates among cluster-associated cases did not differ statistically significantly from those for sporadic nosocomial infections. None of the clusters were identified by the hospital surveillance team. CONCLUSIONS: In an unselected patient population, as many as one-third of all cases of candidemia may be attributable to nosocomial clusters. The risk is dependent on hospital wards and patient populations; it is highest in intensive care units. Small clusters are not identified by routine hospital surveillance.


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