MEKA VG, HADLEY S, DALY J, VENKATARAMAN L, GOLD HS, DEGIROLAMI PC, KARCHMER AW; Interscience Conference on Antimicrobial Agents and Chemotherapy (43rd: 2003: Chicago, Ill.).

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2003 Sep 14-17; 43: abstract no. M-2062.

Beth Israel Deaconess Medical Center, Boston, MA.

BACKGROUND: IFI at sterile sites after OLT are clustered within the initial 30-45 postoperative days. We hypothesized that these IFI resulted from invasion by organisms colonizing patients at the time of OLT. METHODS: We compared the species and PFGE of all yeast recovered from peri and postoperative surveillance cultures of urine, bile, sputum, stool, or wound with yeast causing IFI. Between 8/99 and 8/01, 71 patients at protocol defined high risk for IFI were enrolled in MSG 44, a 13 site double-blind trial comparing fluconazole and ambisome prophylaxis. Germ tube negative isolates were speciated by routine procedures in the microbiology laboratory. For PFGE, C. glabrata were digested with Not I and other species with BssHI. RESULTS: Of the 71 surveillance and invasive isolates from 8 patients with IFI, 44 were C. albicans, 20 C. glabrata, 5 C. tropicalis, and 2 C. parapsilosis. The IFI (peritonitis 5, liver abscess 2, blood 1, IV cath tip 1) in 8 patients (2 pathogens in 3 pts) occurred from day 2 to 89 after OLT (8 of 11 invasive isolates recovered in 14 days) and yielded C. albicans 4, C. glabrata 4, C. tropicalis 1, C. parapsilosis 2 (blood/cath tip). Speciation and PFGE of surveillance isolates and 9 C. albicans surveillance isolates from an uninfected patient indicated unique isolates between patients and stable colonizing yeasts over time in individual patients. 8 of 11 candida IFI isolates were indistinguishable by PFGE from perioperative colonizing isolates (6 of 8 recovered from stool/rectal cultures). C. parapsilosis not isolated perioperatively caused line tip/blood IFI on postop days 3 and 5 in 2 patients. CONCLUSIONS: (1) Unique yeast stably colonize OLT patients over time. (2) Early IFI after OLT is commonly intraabdominal infection caused by yeast colonizing patients, particularly in the GI tract, at the time of surgery.

Publication Types:

• Meeting Abstracts

Keywords:

• AmBisome
• Amphotericin B
• Candida
• Candidiasis
• Electrophoresis, Gel, Pulsed-Field
• Epidemiology, Molecular
• Fluconazole
• Humans
• Liver Transplantation
• Portasystemic Shunt, Transjugular Intrahepatic
• Yeasts
• genetics
• surgery
• transplantation

Other ID:

• GWAIDS0025493

UI: 102265117

From Meeting Abstracts