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Saprochaete clavata Outbreak Infecting Cancer Center through Dishwasher
Abstract:
Saprochaete clavata is a pathogenic yeast responsible for rare outbreaks involving immunocompromised patients, especially those with hematologic malignancies. During February 2016-December 2017, we diagnosed S. clavata infections in 9 patients (8 with fungemia), including 3 within 1 month, at a cancer center in Marseille, France. The patients (median age 58 years), 4 of 9 of whom had acute myeloid leukemia, were hospitalized in 3 different wards. Ten environmental samples, including from 2 dishwashers and 4 pitchers, grew S. clavata, but no contaminated food was discovered. The outbreak ended after contaminated utensils and appliances were discarded. Whole-genome sequencing analysis demonstrated that all clinical and environmental isolates belonged to the same phylogenetic clade, which was unrelated to clades from previous S. clavata outbreaks in France. We identified a dishwasher with a deficient heating system as the vector of contamination.
Insights
Saprochaete clavata outbreaks in cancer patients were linked to contaminated medical equipment. A malfunctioning dishwasher was identified as the source, and discarding contaminated items ended the infections.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Epidemiology
Background:
- Saprochaete clavata is a rare yeast pathogen causing outbreaks in immunocompromised individuals, particularly those with hematologic malignancies.
- Infections can lead to serious conditions like fungemia, posing a significant risk in healthcare settings.
Purpose of the Study:
- To investigate a cluster of Saprochaete clavata infections in a French cancer center.
- To identify the source and transmission route of the yeast during the outbreak.
Main Methods:
- Retrospective case review of patients diagnosed with S. clavata infections between February 2016 and December 2017.
- Environmental sampling of patient wards, including utensils and appliances.
- Whole-genome sequencing (WGS) for phylogenetic analysis of clinical and environmental isolates.
Main Results:
- Nine patients, mostly with acute myeloid leukemia, were diagnosed with S. clavata infections, including eight with fungemia.
- S. clavata was isolated from environmental samples, notably dishwashers and pitchers, but not food.
- Whole-genome sequencing confirmed clinical and environmental isolates belonged to a single, distinct phylogenetic clade.
- A dishwasher with a faulty heating system was identified as the contamination source.
Conclusions:
- A malfunctioning dishwasher served as the likely vector for Saprochaete clavata transmission in this cancer center outbreak.
- Prompt removal of contaminated equipment successfully terminated the outbreak.
- This highlights the importance of environmental hygiene and equipment maintenance in preventing yeast infections in vulnerable patient populations.
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