652. Kodamaea Ohmeri Fungemia Is Not An Uncommon Entity in India: Need for a Systematic Study
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: The frequency of fungemia due to Candida tropicalis is very high in our hospital. While performing a molecular epidemiology study of C. tropicalis strains isolated during August 2008 through November 2008 from pediatric medicine and surgical wards of our hospital, where the fungemia rate was very high, we came across six strains of Kodamaea ohmeri, which were misidentified as C. tropicalis by conventional methods. As only 22 cases of fungemia due to K. ohmeri were reported worldwide till date and these six cases were the largest series from a single center, we conducted the present study.

Methods: All six strains were isolated from blood and were identified by sequencing of D1/D2 region of 26S ribosomal DNA. Patient case records were retrieved. Antifungal susceptibility testing by CLSI M27-A3 protocol, re-identification of yeasts isolated from the hand of health care workers during the same period, and multilocus sequence typing (MLST) of four housekeeping genes were performed.

Results: The age of the patients ranged from neonates to 8 years and two were female; none were neutropenic; all were negative for bacteremia; fungemia was acquired nosocomially in all patients with a mean of 22.1 days post-admission; four patients had fungemia post-surgery. One of the yeasts carried on the hands of a health care worker from the surgical ward was also identified as K. ohmeri. Minimum inhibitory concentration (MIC) of the seven strains were 0.5-1 mg/L for amphotericin B, 0.06-4 mg/L for itraconazole, 1-8 mg/L for fluconazole, 0.03-8 mg/L for voriconazole, 0.06-4 mg/L for posaconazole, and 0.25-2 mg/L for caspofungin. One strain had high MIC for all azoles tested. All six patients were treated with fluconazole (6-12 mg/kg/day) and only one patient died. MLST analysis showed three lineages from those seven strains.

Conclusion: We show that K. ohmeri fungemia is not uncommon in our hospital and probably India. The apparent low incidence may be due to previous misidentification of the yeast isolates. As it is not a single source outbreak (confirmed with molecular typing), K. ohmeri fungemia might be endemic in Indian hospitals and requires a systematic epidemiological study.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Arunaloke Chakrabarti, MD , Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
Mandya R. Shivaprakash, MD , Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
Pratibha Kale, MBBS , Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
Prakash Hariprasath, MSc , Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
Manpreet Dhaliwal, MSc , Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
Mohammed A. Zameer, MS , Pediatric Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
Sunit Singhi, MD , Pediatric Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
Katragadda LN Rao, MCh , Pediatric Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India

Disclosures:

A. Chakrabarti, None

M. R. Shivaprakash, None

P. Kale, None

P. Hariprasath, None

M. Dhaliwal, None

M. A. Zameer, None

S. Singhi, None

K. L. Rao, None

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