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Journal of Clinical Microbiology, September 1999, p. 2817-2828, Vol. 37, No. 9
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
Elucidating the Origins of Nosocomial Infections
with Candida albicans by DNA Fingerprinting with the Complex
Probe Ca3
F.
Marco,1
S. R.
Lockhart,2
M. A.
Pfaller,1
C.
Pujol,2
M. S.
Rangel-Frausto,3
T.
Wiblin,3
H. M.
Blumberg,4
J. E.
Edwards,5
W.
Jarvis,4,6
L.
Saiman,7
J. E.
Patterson,8
M. G.
Rinaldi,9
R. P.
Wenzel,8
The Nemis Study Group,
and
D. R.
Soll2,*
Departments of
Biology,2
Medicine,3 and
Pathology,1 University of Iowa, Iowa
City, Iowa; Emory University School of
Medicine4 and Centers for Disease
Control and Prevention,6 Atlanta, Georgia;
University of California School of Medicine, Los Angeles,
California5; Columbia University, New
York, New York7; University of Texas
Health Science Center, San Antonio, Texas9; and
Medical College of Virginia, Virginia Commonwealth
University, Richmond, Virginia8
Received 10 February 1999/Returned for modification 6 April
1999/Accepted 14 May 1999
Computer-assisted DNA fingerprinting with the complex probe Ca3 has
been used to analyze the relatedness of isolates collected from
individuals with nosocomial bloodstream infections (BSIs) and hospital
care workers (HCWs) in the surgical and neonatal intensive care units
(ICUs) of four hospitals. The results demonstrate that for the majority
of patients (90%), isolates collected from commensal sites before and
after collection of a BSI isolate were highly similar or identical to
the BSI isolate. In addition, the average similarity coefficient for
BSI isolates was similar to that for unrelated control isolates.
However, the cluster characteristics of BSI isolates in dendrograms
generated for each hospital compared to those of unrelated control
isolates in a dendrogram demonstrated a higher degree of clustering of
the former. In addition, a higher degree of clustering was observed in
mixed dendrograms for HCV isolates and BSI isolates for each of the
four test hospitals. In most cases, HCW isolates from an ICU were
collected after the related BSI isolate, but in a few cases, the
reverse was true. Although the results demonstrate that single,
dominant endemic strains are not responsible for nosocomial BSIs in
neonatal ICUs and surgical ICUs, they suggest that multiple endemic
strains may be responsible for a significant number of cases. The
results also suggest that cross-contamination occurs between patients and HCWs and between HCWs in the same ICU and in different ICUs. The
temporal sequence of isolation also suggests that in the majority of
cases HCWs are contaminated by isolates from colonized patients, but in
a significant minority, the reverse is true. The results of this study
provide the framework for a strategy for more definitive testing of the
origins of Candida albicans strains responsible for
nosocomial infections.
*
Corresponding author. Mailing address: Department of
Biological Sciences, University of Iowa, Iowa City, IA 52242. Phone: (319) 335-1117. Fax: (319) 335-2772. E-mail:
david-soll{at}uiowa.edu.

Members of the NEMIS (National Epidemiology of Mycoses Survey)
Study Group are M. Costigan, E. Ludington, and J. Dawson, University
of
Iowa; H. New (deceased), Columbia University; M. Marten, Oregon
Health
Science University; J. Dibb and C. Roldan, University of
Texas; and D. Webb, Pfizer
Inc.
Journal of Clinical Microbiology, September 1999, p. 2817-2828, Vol. 37, No. 9
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
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