JCM Accepts, published online ahead of print on 12 March 2014 J. Clin. Microbiol. doi:10.1128/JCM.00131-14 Copyright © 2014, American Society for Microbiology. All Rights Reserved.
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Epidemiology of Candida kefyr in Patients with Hematologic Malignancies
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Simon F. Dufresne1,2, Kieren A. Marr1,3, Emily Sydnor1,4, Janet F. Staab1, Judith E. Karp3, Kit Lu3,5, Sean X.
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Zhang6, Christian Lavallée2, Trish M. Perl1,7, and Dionysios Neofytos1*
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Baltimore, MD;
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Division of Infectious Disease, Department of Medicine, Johns Hopkins University School of Medicine,
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Department of Microbiology and Immunology, Université de Montréal, Montreal, Qc, Canada;
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Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine;
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Division of Infectious Diseases, University of Utah, Salt Lake City, UT;
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Department of Hematology, National Institute of Health, Bethesda, MD;
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Department of Pathology, Johns Hopkins University School of Medicine;
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Epidemiology and Infection Prevention, Johns Hopkins Medicine.
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Running title: C. kefyr in patients with hematologic malignancies
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Address correspondence to: Kieren A. Marr,
[email protected]
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*Present address: Dionysios Neofytos, Infectious Diseases Service, Memorial Sloan-Kettering Cancer
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Center, New York, NY.
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ABSTRACT
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Candida kefyr (Ck) is an emerging pathogen among patients with hematologic malignancies (HM). We
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performed a retrospective study at Johns Hopkins Hospital to evaluate the epidemiology of Ck colonization
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and infection in HM patients between 2004 and 2010. 83 patients were colonized and/or infected with Ck,
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with 8 (9.6%) having invasive candidiasis (IC). The yearly incidence of Ck colonization and candidemia
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increased over the study period (p2 weeks after admission to the hospital in the majority of patients (66; 79.5%).
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There were nine episodes of Ck IC in eight patients (Table 2). Patient 5 had two episodes of Ck IC one year
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apart: the first due to likely gastrointestinal translocation and the second retrieved coincident with a bladder
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fungus ball. Only one patient had confirmed catheter-related candidemia and was not neutropenic at the time
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of first positive blood culture. Most episodes occurred between July and September (6/9) or in 2009-2010
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(6/9). Five episodes were breakthrough infections occurring coincident with antifungal therapy (liposomal
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amphotericin B, n=2; micafungin, n=3).
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Antimicrobial susceptibility testing data was available for 13 isolates from patients with Ck IC. All
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breakthrough isolates were resistant to the ongoing antifungal therapy. Detailed culture data with minimal
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inhibitory concentrations (MIC; μg/mL) are presented in Table 3.
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Trends in Ck colonization and candidemia among HM patients
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A total of 1844 patients admitted to two HM-dedicated wards (A and C) had 12,478 surveillance cultures
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sent during the study period. From these, 66 patients had 153 cultures yielding Ck, with a positivity rate and
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incidence of 1.2% and 3.6%, respectively. Seventeen of the 83 HM patients from the primary study patient
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population were not captured by this analysis: in six, Ck was found in a specimen other than a surveillance
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culture, and 11 patients were not hospitalized on the two targeted wards at the time the Ck-positive specimen
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was collected. A total of 89 candidemia episodes occurred in this cohort, 7 (7.9%) of which were caused by 8
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Ck. One patient with Ck candidemia described in Table 2 was not captured in this analysis because he was
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hospitalized on another ward at the time of candidemia.
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Overall, there was a significant increase in yearly incidence of Ck colonization during the study period
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(linear trend, p
