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Candida albicans outbreak associated with total parenteral nutrition in the neonatal unit
H Guducuoglu1, B Gultepe, B Otlu
1Department of Medical Microbiology, School of Medicine, Yuzuncu Yil University, Van, Turkey.
Background:
The most frequently isolated fungi in patients using TPN belongs to the Candida genus. Various infections including venous catheter infections, fungemia, endocarditis and ophthalmitis may be encountered.
Objective:
Upon growth of Candida in the blood cultures from the pediatric (neonatal) unit of our hospital, a surveillance was performed in this unit and involving the health care workers. Clonal relationships of the isolates were investigated with molecular tests.
Methods:
Blood samples obtained from the patients in pediatric neonatal unit were studied with automatized blood culture [BacT/Alert (Bio Mιrioux, France)]. Yeast isolates from environmental surveillance cultures (TPN solutions, hands of healthcare personnel, ιtagθre, etc) and patients were identified as C. albicans with conventional methods and ID 32 C and ATB TM Fungus 3 (Biomerieux, France) kits. Clonal similarity was determined by using AP-PCR as initial method and we have also typified all strains by the method of REP-PCR (diversilab system,bioMιrieux). Finally; Pulsed Field Gel Electrophoresis (PFGE) was used for confirmation.
Results:
C. albicans was isolated in blood cultures of seven patients. Similar antifungal susceptibility patterns were observed in all isolates. AP-PCR and REP-PCR showed that the C. albicans isolates grown in the TPN solution and from the patients' blood cultures were clonally same strains. PFGE analysis further confirmed this clonality.
Conclusion:
According to results of the molecular methods, we thought that a C. albicans outbreak had occurred in the neonatal pediatric unit, due to contamination of TPN solution.
Insights
A Candida albicans outbreak likely occurred in a neonatal unit, originating from contaminated TPN solutions. Molecular testing confirmed clonal relationships between yeast isolates from patients and the TPN.
Area of Science:
- Medical Mycology
- Infectious Disease Epidemiology
- Molecular Microbiology
Background:
- Candida species are common fungal pathogens in patients receiving total parenteral nutrition (TPN).
- These infections can lead to serious complications such as fungemia and endocarditis.
- Neonatal units are particularly vulnerable to hospital-acquired infections.
Purpose of the Study:
- To investigate a suspected Candida outbreak in a neonatal unit.
- To determine the clonal relationship of Candida isolates from patients and the environment.
- To identify the source of infection in TPN-dependent neonates.
Main Methods:
- Automated blood cultures and environmental surveillance were employed.
- Candida albicans identification was confirmed using conventional methods and commercial kits.
- Molecular typing techniques including AP-PCR, REP-PCR, and Pulsed Field Gel Electrophoresis (PFGE) were utilized to assess clonal similarity.
Main Results:
- Seven patients in the neonatal unit had Candida albicans isolated from blood cultures.
- All isolates exhibited similar antifungal susceptibility patterns.
- Molecular analyses (AP-PCR, REP-PCR, PFGE) demonstrated clonality between C. albicans from patients' blood and TPN solutions.
Conclusions:
- The findings strongly suggest a Candida albicans outbreak in the neonatal pediatric unit.
- Contamination of TPN solutions is identified as the probable source of the outbreak.
- Molecular epidemiology was crucial in confirming the outbreak and its source.
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