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Pichia anomala outbreak in a nursery: exogenous source?
P A Aragão1, I C Oshiro, E I Manrique
1Infection Control Department, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
Background:
Pichia anomala is a rare cause of fungemia. From February to April, 1998, eight cases of fungemia occurred in the intensive care and high risk units of the Nursery. There were four infants with P. anomala infection, one of whom also had Candida parapsilosis infection, two cases with C. parapsilosis infection and two with Candida albicans infection.
Objective:
To determine factors associated with fungemia in the intensive care and high risk units of the Nursery, especially P. anomala.
Methods:
A cohort study with 59 newborns.
Results:
Factors associated with fungemia were: central venous catheter (CVC) (P = 0.0006); total parenteral nutrition (TPN) (P = 0.0005); lipid emulsion (P = 0.002); previous antimicrobial use (P = 0.002); and other invasive procedures (P = 0.002). Factors associated with P. anomala fungemia were: CVC (P = 0.004); TPN (P = 0.018); previous antibiotic use (P = 0.037); and other invasive procedures (P = 0.037). Evaluation of the units demonstrated that there were several technical problems involving administration of TPN that was manipulated in the Nursery without precautions. Changes in TPN formulation and education as to adequate technique were implemented. During follow-up (1998 to 1999) only two fungemias occurred that were caused by C. albicans. Cultures of hands of personnel were negative for P. anomala. Electrophoretic karyotyping of P. anomala showed three profiles.
Conclusions:
Factors associated with fungemia were catheter use, invasive procedures and total parenteral nutrition, suggesting that the acquisition of P. anomala was exogenous.
Insights
Pichia anomala fungemia in newborns is linked to central venous catheters, total parenteral nutrition, and invasive procedures. Interventions reduced subsequent infections, suggesting exogenous acquisition of this rare pathogen.
Area of Science:
- Medical Mycology
- Neonatal Intensive Care
- Infectious Diseases
Background:
- Pichia anomala is an infrequent cause of fungemia, particularly in neonatal intensive care settings.
- An outbreak of eight fungemia cases occurred between February and April 1998, with four cases attributed to P. anomala.
Purpose of the Study:
- To identify risk factors for fungemia in neonatal intensive care units, with a specific focus on P. anomala.
- To investigate the source and contributing factors of P. anomala fungemia in neonates.
Main Methods:
- A cohort study involving 59 newborns was conducted.
- Statistical analysis was used to determine factors associated with fungemia and P. anomala fungemia.
Main Results:
- Central venous catheter use, total parenteral nutrition (TPN), lipid emulsions, prior antimicrobial therapy, and invasive procedures were significantly associated with fungemia.
- P. anomala fungemia was specifically linked to central venous catheters, TPN, previous antibiotic use, and invasive procedures.
- Technical issues in TPN administration were identified as a potential source, leading to implemented changes in formulation and technique.
Conclusions:
- Catheter use, invasive procedures, and TPN are key risk factors for fungemia in this neonatal population.
- The findings suggest that P. anomala infections were acquired exogenously, likely related to TPN handling.
- Post-intervention, a significant reduction in fungemia cases was observed.