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To compare the epidemiology and genetic relatedness of Candida tropicalis isolates causing bloodstream infection (BSI) in two hospitals.
Two tertiary-care hospitals in Korea.
A retrospective molecular epidemiologic analysis using pulsed-field gel electrophoresis (PFGE) was performed with 49 C. tropicalis isolates from sporadic cases of BSI. The isolates were collected from 27 patients at Chonnam National University Hospital (CUH) during a 6-year period and 22 patients at Asan Medical Center (AMC) during a 2-year period.
Based on the PFGE patterns, the average similarity value (SAB) for the 27 isolates from CUH was 0.84 ± 0.08, which was significantly higher than that for the 22 isolates from AMC (0.78 ± 0.06; P < .001). Of the 49 strains from patients at the 2 hospitals, 9 isolates were placed into 3 subtypes with SAB values of 1.0, which indicated that they were identical. All 9 of these strains were isolated from CUH patients, and each type strain was isolated sporadically during a period ranging from 4 months to 3 years. On comparison of the clinical characteristics of the patients of the 2 hospitals, the CUH strains were isolated more frequently from non-neutropenic patients and patients with central venous catheter–related fungemia; cases from CUH had a better outcome than those from AMC (P < .05).
These data show that the clinical and epidemiologic characteristics of C. tropicalis fungemia may differ markedly among hospitals and that some cases of C. tropicalis fungemia may be caused by endemic strains within a hospital.
To determine the degree to which species identification or strain relatedness assessment of successive blood culture isolates of coagulase-negative staphylococci (CNS) may improve the clinical diagnosis of bloodstream infection (BSI).
400-bed community hospital.
Prospective laboratory survey during which all CNS blood culture isolates obtained between mid-August 1996 and mid-February 1997 (study period) were saved and later identified to the species level; selected isolates were genotyped using pulsed-field gel electrophoresis at the Centers for Disease Control and Prevention (CDC). Retrospective review of medical records of 37 patients with multiple cultures positive for CNS.
During the study period, 171 patients had blood cultures positive for CNS; 130 had single positive cultures and 41 had ≥2 positive cultures. Of these 41, 23 (62%) were from patients with signs and symptoms of BSI according to CDC surveillance definitions. Species identification and strain clonality of CNS isolates from patients with ≥2 positives revealed 3 (13%) of the 23 patients did not have a consistent CNS species, and another 3 (13%) did not have a consistent genotype in the ≥2 positive cultures, suggesting that CNS from these patients probably were contaminants. Thus, species identification and strain clonality assessment reduced by 27% the number of patients with BSI diagnosed based on the presence of symptoms and ≥2 positive blood cultures.
Routine species identification and selected strain genotyping of CNS may reduce the misinterpretation of probable contaminants among patients with ≥2 positive blood cultures.
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