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An outbreak of candidemia due to Candida tropicalis in a neonatal intensive care unit

A Chowdhary1, K Becker, W Fegeler

  • 1Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110 007, India. dranuradha@hotmail.com

Mycoses
|September 3, 2003
PubMed

Insights

A Candida tropicalis outbreak infected 16 neonates, causing respiratory distress. Environmental sampling and genotyping suggest a common source for this serious bloodstream infection in vulnerable infants.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Neonatal Care

Background:

  • Neonates, particularly those born prematurely (gestational age 28-36 weeks), are susceptible to invasive fungal infections.
  • Hyperalimentation and broad-spectrum antibiotic use are known risk factors for candidemia in neonatal intensive care units.
  • Candida tropicalis is an emerging cause of invasive candidiasis, especially in immunocompromised populations.

Purpose of the Study:

  • To report and characterize an outbreak of candidemia caused by Candida tropicalis in a neonatal intensive care unit.
  • To identify potential sources and transmission routes of Candida tropicalis during the outbreak.
  • To investigate the genetic relatedness of clinical and environmental isolates.

Main Methods:

  • Retrospective review of clinical data for 16 neonates diagnosed with candidemia.
  • Microbiological investigation including blood and urine cultures.
  • Environmental sampling of patient care items (blankets, mattresses).
  • Molecular typing of Candida tropicalis isolates using arbitrarily primed-PCR.

Main Results:

  • Sixteen neonates developed candidemia due to Candida tropicalis; all received hyperalimentation and antibiotics.
  • Common clinical features included acute respiratory distress and non-response to antibacterial therapy.
  • Candida tropicalis was isolated from blood (16/16) and urine (14/16) of affected neonates. Environmental isolates from blankets and mattresses were also identified.
  • Arbitrarily primed-PCR demonstrated that a majority of urinary tract and all environmental isolates shared the same genotype, suggesting a common source.

Conclusions:

  • Candida tropicalis can cause significant outbreaks of candidemia in vulnerable neonatal populations.
  • Environmental contamination likely played a role in the transmission of Candida tropicalis during this outbreak.
  • Genotyping confirmed the clonal origin of isolates, highlighting the importance of infection control measures and environmental surveillance.

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