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Published on: July 24, 2016
Outbreak of Pichia kudriavzevii fungaemia in a neonatal intensive care unit
T Nagarathnamma1, Sneha K Chunchanur1, Shivaprakash M Rudramurthy2
1Department of Microbiology, Bangalore Medical College and Research Institute, Bangalore, India.
Purpose:
Fungaemia is associated with substantial morbidity and mortality in neonates admitted to neonatal intensive care units (NICUs). We report an outbreak of fungaemia in a NICU due to rare yeast, Pichia kudriavzevii (a teleomorph of Candida krusei). To the best of our knowledge, this is the first report of neonatal sepsis due to P. kudriavzevii.
Methodology:
Between August and September 2014, blood cultures from nine neonates diagnosed with late-onset sepsis in the NICU yielded yeast-like organisms. The molecular identification and typing of these isolates was performed by sequencing the D1/D2 region of 26S rDNA and fluorescent amplified fragment length polymorphism (FAFLP) respectively. Antifungal susceptibility was tested by broth microdilution as per the Clinical Laboratory Standards Institute (CLSI) guidelines. Sampling from environmental sources and the hands of healthcare workers (HCWs) in the NICU was performed.
Results:
Of the nine neonates, eight were preterm and six had very low birth weight (VLBW). Thrombocytopenia was present in two neonates. Sequencing identified all the isolates as P. kudriavzevii and FAFLP showed their clonal origin. Antifungal susceptibility testing revealed the susceptibility of all isolates to the antifungals tested. Treatment with voriconazole was advised. However, only seven neonates were treated successfully and discharged after improvement, whereas two were lost for follow-up. Cultures from the environment and the hands of HCWs were negative. The outbreak was controlled by the strict implementation of infection control practices.
Conclusion:
This study emphasizes the importance of accurate identification of the aetiological agent of sepsis and vigilant monitoring for the possibility of an outbreak in NICUs.
Insights
A rare yeast, Pichia kudriavzevii, caused a fungaemia outbreak in a neonatal intensive care unit (NICU). Strict infection control practices successfully managed the outbreak, highlighting the need for accurate pathogen identification in neonatal sepsis.
Area of Science:
- Neonatal Intensive Care Unit (NICU) Infections
- Medical Mycology
- Infectious Disease Epidemiology
Background:
- Fungaemia poses significant risks to neonates in NICUs, contributing to morbidity and mortality.
- Neonatal sepsis outbreaks require prompt identification and management of the causative agent.
Purpose of the Study:
- To report the first known outbreak of neonatal sepsis caused by the rare yeast Pichia kudriavzevii (teleomorph of Candida krusei).
- To investigate the source and control measures for a P. kudriavzevii fungaemia outbreak in a NICU.
Main Methods:
- Molecular identification (26S rDNA sequencing) and typing (FAFLP) of yeast isolates from nine neonates.
- Antifungal susceptibility testing using CLSI guidelines.
- Environmental and healthcare worker sampling to identify the source of infection.
Main Results:
- All nine isolates were identified as Pichia kudriavzevii, with clonal origin confirmed by FAFLP.
- All isolates were susceptible to tested antifungals; voriconazole treatment was advised.
- Environmental and HCW cultures were negative; outbreak control was achieved through strict infection control.
Conclusions:
- Accurate identification of sepsis aetiology is crucial in NICU settings.
- Vigilant monitoring for and rapid response to potential outbreaks are essential for patient safety.
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