Molecular Epidemiology of the Global and Temporal Diversity of Candida albicans

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Abstract
The epidemiology of Candida albicans has changed with the rise in immunocompromised patients and the pressures of antifungal treatment and prophylaxis. We assessed the genotype distribution of recently obtained, globally diverse isolates in comparison with isolates recovered in the United States and United Kingdom before 1985, in order to determine temporal and geographic differences. We used EcoRI digestion of cellular DNA to generate restriction fragment length polymorphisms, dividing the isolates into 4 groups. From 15 diverse geographic areas, 439 isolates obtained over 20 years were divided into 121 genotypes within groups A (289 isolates), B (85), C (56), and D (9). Differences in genotype distribution existed among the localities (P < .0001) and between isolates obtained before 1990 versus those recovered since then (P = .009). Comparison of pre-1985 United States/United Kingdom isolates with post-1994 United States isolates revealed a trend toward a changing genotype distribution (P = .057). Global post-1985 isolates were different in genotype distribution from United States/United Kingdom isolates (P < .0001). The distribution of isolates from Israel was unique (P < .0001). These differences could be due in part to the increasing prevalence of group C strains worldwide.